Background: Patients with pre-transplant left ventricular assist devices (LVAD) develop circulating antibodies with potential donor reactivity after cardiac transplantion. The aim of this study was to review the clinical outcomes in our bridge to transplant (BTT) patients.

Methodology: Data was collected for patients implanted with BTT-LVADs who were successfully transplanted over a 3-year period. Peak pre-transplant panel reactive antibodies (PRA) were noted for each patient and were compared to determine the impact of LVAD therapy on humoral sensitization, acute rejection and mortality.

Results: A total of 20 patients with BTT-LVAD placement were successfully transplanted. The median age of cohort was 54.5 (26-70) years. Most patients were males (n=16) and caucasians (n=11). Elevated PRAs (>10%) were found in 50% patients. All but one patient (paracorporeal VAD) underwent placement of continuous-flow LVADs. Patients were dichotomized based on peak PRA <=10% and >10%. There was no difference in the age (p=0.71), gender (p=0.08) or race (p=0.80) between the groups. There was no difference in the number of episodes of acute rejection between the groups (3.3+/-3.6 episodes in PRA>10% vs. 2.2+/-1.4 episodes in PRA<10%; p=0.39). There was 100% survival in our cohort at a median of 523 days (121-1786 days).

Conclusion: Patients on mechanical assist device support are at high risk of humoral sensitization. This difference in sensitization however did not translate into substantial differences in the clinical outcomes of rejection or mortality.

« Back to 2013 American Transplant Congress