Date: Monday, May 1, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Primary graft dysfunction (PGD) following orthotopic heart transplant (OHT) is one of the leading causes of posttransplant mortality. We hypothesized that antibody to angiotensin type II receptor 1 (AT1R) was associated with PGD in OHT patients with ventricular assist device (VAD) as bridge to OHT. PGD was defined as ≥ 1 of the following within 72 hr of OHT: right or left atrial pressure >18 mmHg; cardiac index <2.2 L/min/m2; high dose epinephrine or norepinephrine; open chest; or ECMO or VAD. From 2012-16 a total of 55 patients in the UCLA Advanced Heart Failure program underwent VAD implant with subsequent transplant. Pre and posttransplant sera from 35 patients were assayed for AT1R antibody. Patients were excluded from the study if a pre-VAD serum was unavailable, or if the post-VAD sample was >12 days post OHT. Samples were stratified by the presence of AT1R antibody >10 U/ml that is associated with endothelial cell dysfunction. Post-VAD samples were a median of 53 days (range: 17-168) from VAD implant and a median of -20 days (range: -847-12) to day of transplant. The majority of patients were negative for AT1R antibodies in pre-VAD sera (n=33, 94.3%). Two patients (5.7%) had AT1R antibodies >40 U/ml in pre- and post-VAD seras. After VAD implant, 45.5% (15/33) of patients converted to AT1R >10 U/ml. In patients who converted to AT1R >10 U/ml there was no difference in patient age, sex, race, diabetes mellitus status, history of smoking or prior cardiac surgery, device type, ischemic time, UNOS status or presence of preformed HLA donor specific antibodies. The incidence of PGD was significantly increased in patients who converted to AT1R >10 U/ml after VAD implant as compared to those who did not convert (80% vs 45%, p<0.036). In patients who converted to AT1R >10 U/ml, donor age was also significantly increased in comparison to those that did not convert (36.5 vs 28.4 years, p<0.039). These data suggest that VAD placement leads to AT1R antibody production associated with PGD after transplant.
CITATION INFORMATION: Hickey M, DePasquale E, Shah S, Vucicevic D, Zhang J, Valenzuela N, Deng M, Reed E. Antibodies to Angiotensin Type II Receptor I Are Associated with Primary Graft Dysfunction After Orthotopic Heart Transplant in Patients with Ventricular Assist Device as Bridge to Transplant. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Hickey M, DePasquale E, Shah S, Vucicevic D, Zhang J, Valenzuela N, Deng M, Reed E. Antibodies to Angiotensin Type II Receptor I Are Associated with Primary Graft Dysfunction After Orthotopic Heart Transplant in Patients with Ventricular Assist Device as Bridge to Transplant. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/antibodies-to-angiotensin-type-ii-receptor-i-are-associated-with-primary-graft-dysfunction-after-orthotopic-heart-transplant-in-patients-with-ventricular-assist-device-as-bridge-to-transplant/. Accessed July 5, 2020.
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