Outcomes after heart transplantation in sensitized patients bridged with ventricular assist devices. Issue 6 (2nd May 2019)

• Record Type: Journal Article
• Authors: Fraser, Charles D.; Zhou, Xun; Magruder, J. Trent; Suarez‐Pierre, Alejandro; Lui, Cecillia; Grimm, Joshua C.; Higgins, Robert; Kilic, Ahmet
• Is Part Of: Journal of cardiac surgery. Volume 34:Issue 6(2019)
• Page Start: 474
• Page End: 481
• Publication Date: 2019-05-02
• Subjects: heart transplantation -- panel‐reactive antibody -- sensitization; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.14066
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Objective: Sensitization has been associated with worse outcomes following heart transplantation (HTx). The use of ventricular assist devices (VAD) is a risk factor for the development of sensitization. We investigated the impact of left ventricular assist devices (LVAD) and sensitization in HTx recipients. Methods: We queried the UNOS database for all heart transplants performed from January 2000 through December 2016. Patients were considered highly sensitized and included if panel‐reactive antibody (PRA) activity was 25% or higher. Patients were separated by pretransplant LVAD utilization and subgroup analysis was performed by device type (HeartMate II or HeartWare). Outcomes included Kaplan‐Meier survival and episodes of rejection within 1 year of HTx. Results: Of 18 009 recipients, 2434 (14%) were highly sensitized. 1055 (43.3%) were bridged with a VAD. In multivariate analysis, LVAD use did not impact 1‐year (hazards ratio [HR], 1.30; P = 0.052) or 5‐year survival (HR, 1.18; P = 0.112) in highly sensitized recipients. Furthermore, episodes of rejection were not affected by LVAD status ( P = 0.765). Of the 1055 sensitized LVAD‐bridged transplant recipients, 624 (59%) were implanted with a HeartMate II and 99 (9.4%) were bridged with a HeartWare device. In multivariate analysis, no differences were observed in 1‐year survival (HR, 0.86; P = 0.664), 5‐year survival (HR, 1.35; P = 0.209), or episodes of rejection ( P = 0.497). Conclusions: The use of ventricular assist devices did not impact survival or rejection within 1 year of HTx in highly sensitized patients. Highly sensitized recipients have similar outcomes regardless of prior LVAD support or type of LVAD used as a bridge to transplantation.