*Purpose: Left ventricular assist device (LVAD) implantation is followed by a sharp increase in serum levels of IgG natural antibodies (Nabs) recognizing oxidation-specific epitopes (OSE) and apoptotic cells. The consequence of IgG Nabs production following LVAD is not known. We hypothesized that Nabs following implant may be associated with LVAD complications, promoting thrombosis, stroke or bleeding.

*Methods: We studied a multicenter cohort (n=71) of adults who received a continuous flow LVAD at three university hospitals in the United States. Nabs were measured in longitudinal sera by assessing IgG reactivity to the OSE malondialdehyde (MDA) and to apoptotic Jurkat cells. Wilcoxon’s signed rank test for matched pairs was used to compare measurements.

*Results: Mean IgG Nabs levels were significantly increased in post-LVAD sera at 1 (0.41±0.05 Nabs units, p<0.0001), 6 (0.63±0.074, p<0.0001) and 12 months (0.49±0.69, p=0.0004) compared to pre-LVAD (0.19±0.021). Kinetics of Nabs development was found to differ between centers with 90.9% of center 1 patients developing elevated Nabs at 6 months post-implantation compared to 30% and 29.7% for center 2 and center 3, respectively. Preliminary analysis revealed elevated Nabs in 2/3 center 3 patients with pump thrombosis and 1/2 with stroke within the first year post-LVAD.

*Conclusions: Our studies revealed that serum IgG Nabs are elevated following LVAD implant. The appearance of Nabs differed between the centers. We are investigating the possible contribution of differing perioperative procedures on Nabs development. Preliminary findings suggest that IgG Nabs may be associated with thromboembolism. Analysis of adverse events in the other centers are forthcoming.

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