Purpose: Ventricular assist devices (VAD) have been shown to lead to immune activation and higher frequencies of autoantibodies. Previous research reports a rate of 30% false positive hepatitis C antibody (FPHC) after VAD implantation. Our study aims to further describe the clinical, epidemiological, and laboratory characteristics of this population.
Methods: We identified 48 adult VAD recipients who bridged to heart transplantation from January 2007 to January 2013 at Montefiore Medical Center. Clinical data were obtained from medical records. FPHC results were confirmed with pre- and post-VAD Hepatitis C ELISA antibody tests, and confirmatory testing with Hepatitis C RNA PCR and/or radioimmunoblot assay.
Results: 48 VAD patients were identified, of whom 5 did not have complete Hepatitis C serologies and were excluded. Of the 43 remaining patients, 11 (26%) had FPHC. There were no confirmed cases of hepatitis C. Mean age at VAD placement and heart transplantation was 54 and 55, respectively; 17(40%) patients had non-ischemic cardiomyopathy as an underlying reason for VAD, and 32(74%) had Heartmate II VAD implantation. There was an overall significant increase between pre- and post-VAD rheumatoid factor (RF), anti-nuclear antibody, albumin/globulin ratio, and globulin fraction, however no difference between the FPHC and negative antibody group. Age at VAD and heart transplantation, total blood products received during and after VAD index hospitalization and packed RBC units transfused during subsequent admission were significantly correlated with FPHC, while RF, VAD-related infection, and endocarditis trended towards statistical significance between patients with and without FPHC.
Conclusions: Post-VAD patients show evidence of immune activation and increased autoantibodies. Patients with FPHC are older at VAD implantation and heart transplantation, and received more post-VAD RBC units. Clinicians should be aware of this increased risk of FPHC in older VAD patients in order to avoid unnecessary alarm, and possible delay in transplantation. Further studies should examine specific autoantibodies within serum or red blood cells, which may also contribute to VAD-related immune activation.
To cite this abstract in AMA style:Lee D, Levy D, Shuter J, Minamoto G, Goldstein D, D'Alessandro D, Muggia V. False Hepatitis C Antibody Development in Left Ventricular Assist Device Recipients Who Proceed to Heart Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/false-hepatitis-c-antibody-development-in-left-ventricular-assist-device-recipients-who-proceed-to-heart-transplantation/. Accessed January 25, 2021.
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