Title

De novo human leukocyte antigen allosensitization patterns in patients bridged to heart transplantation using left ventricular assist devices

Authors

Vinh Q. Chau, Advocate Aurora HealthFollow
Jason Feinman, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Kerianne Fullin, Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
Kiran Mahmood, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Estefania Oliveros, Heart and Vascular Institute, Section of Cardiology, Lewis Katz School of Medicine, Philadelphia, PA, United States of America.
Sumeet S. Mitter, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Sean P. Pinney, Division of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States of America.
Donna M. Mancini, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Anuradha Lala, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Noah Moss, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America. Electronic address: noah.moss@mountsinai.org.

Affiliations

Advocate Heart Institute, Advocate Christ Medical Center

Abstract

INTRODUCTION: We examined the impact and time course of de novo human leukocyte antigen (HLA) allosensitization following left ventricular assist device (LVAD) implantation. METHODS AND RESULTS: Forty patients had a calculated panel reactive antibody (cPRA) prior to LVAD surgery between January 2014 and December 2018. Of these patients, we retrospectively studied 33 patients who had pre-LVAD cPRA <10%. De novo allosensitization was defined as cPRA ≥10% within 3 months following LVAD surgery, and "persistent allosensitization" was defined as cPRA ≥10% at time of heart transplant or death. One-third (11/33) of our cohort developed de novo allosensitization within 3-months post-LVAD. Median duration of follow-up during LVAD support was 588 days (IQR 337-1071 days), or approximately 19 months. In an adjusted, multivariable analysis, female sex remained associated with de novo allosensitization (adjusted odds ratio [95%CI]: 11 (1.4-85), P = 0.026). De novo allosensitization was subsequently associated with persistent allosensitization (P = 0.024). Both axial-flow and centrifugal-flow LVADs had similar rates of allosensitization. Compared to those with no allosensitization, patients with de novo allosensitization did not appear to have inferior post-transplant outcomes of death or treated rejection. CONCLUSION: In our single-center experience, one-third of patients developed de novo allosensitization which did not appear to associate with inferior post-transplant outcomes. Female sex was associated with de novo allosensitization.

Document Type

Article

PubMed ID

35278648


 

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