LVAD TREATED HEART RECIPIENTS DO NOT HAVE DELETERIOUS HLA ANTIBODY.
RH Kerman, B Radovancevic, P Przybylowski, C Thomas, OH Frazier, BD Kahan. Univ of Texas Medical School – Houston, Texas
Left ventricular assist devices (LVADs) are life-saving bridges to heart transplantation. LVAD treated patients receive blood transfusions which can lead to anti-HLA antibodies and may increase the risk of rejection and graft loss in heart recipients. Not all transplant centers experience these sensitization problems with LVAD-treated heart allograft recipients. We evaluated our experience with LVAD vs non-LVAD treated heart allograft recipients by correlating HLA allosensitization to rejections and graft survival in transplanted recipients during the first 12 months post transplant. HLA sensitization (PRA > 10%) was determined by an ELISA assay detecting IgG anti-HLA bound to soluble HLA target antigen. Of the 80 LVAD patients, 18% were sensitized before and 14% following LVAD implantation and blood product transfusion for a total of 32% sensitized (23 + 12% PRA) LVAD patients. Of the 80 LVAD patients, 44 received heart allografts within 6 + 5 months following LVAD implantation and 32% were sensitized (27 + 14% PRA) before transplantation. LVAD-treated heart recipients (sensitized or non-sensitized) all experienced comparable rejection frequencies of approximately 50% and one-year graft survivals of approximately 87%. Non-LVAD heart recipients experienced comparable rejection frequencies and one-year graft survivals whether they were sensitized or non-sensitized. However, the rejection frequency of 79% for non-LVAD heart recipients was significantly greater than the 47% for LVAD-treated recipients (p<0.001), suggesting that the LVAD process may result in protection. The one-year graft survivals of 83% and 86% were comparable. The data suggest that HLA allosensitization is not a clinical risk factor for LVAD-treated heart recipients.