Abstract 20395: High Incidence of Elevated Panel Reactive Antibodies in Patients Supported with HeartMate II Left Ventricular Assist Devices
Background: A high prevalence of panel reactive antibodies (PRA) has been described in patients supported with pulsatile HeartMate I left ventricular assist devices (LVAD). Elevated PRA negatively impact wait times and transplantation outcomes. We examined changes in PRA profiles of patients supported with continuous flow HeartMate II (HMII) LVADs.
Methods: We performed a retrospective review of prospectively collected immunology data on all patients supported with HMII LVADs from January 2004 to June 2010 at our center. Pre-transplant PRA levels >10% and any detectable PRA after transplant defined “sensitization.”
Results: Data for 80 HMII patients were analyzed. Of these, 11.6% were sensitized prior to implant, and 32.0% were newly sensitized during device support. Patient sex, age, and duration of support were major risk factors for PRA development: pre-LVAD, 5 of 19 female and 3 of 50 male patients had PRA>10% (p-value=0.019). During LVAD support, 13 of 18 female (72%) and 11 of 57 (19.3%) male patients developed PRA>10% (p-value<0.001). Sensitized patients were significantly younger (45.9±12.4 vs 54.3±13.5 years; p=0.012) and had longer LVAD support times (321.6±169.6 vs 209.9±207.3 days; p=0.024). Twelve of 24 sensitized patients were treated with IVIG and cyclophosphamide; 1 patient received IVIG only. Fifty-one patients underwent transplantation during the observation period: 13 of 37 (28.9%) non-sensitized and 4 of 8 (50.0%) sensitized patients experienced at least 1 rejection episode within 5 years of transplantation (p-value=0.432). There were no long-term survival differences between the sensitized and non-sensitized groups.
Conclusions: Allosensitization occurs in a significant number of patients supported with HMII LVADs, and is associated with longer LVAD support duration, younger age, and female gender. Age and gender should be taken into consideration when evaluating risk/benefit profiles of LVAD as bridge to transplantation.
- © 2010 by American Heart Association, Inc.