Impact of Infections on Patients with Left Ventricle Assist Devices(LVAD): Allo-Sensitization and Heart Transplantation
Virginia Commonwealth University, Richmond.
Meeting: 2018 American Transplant Congress
Abstract number: 167
Keywords: Antibodies, Heart transplant patients, Rejection, Ventricular assist devices
Session Information
Date: Sunday, June 3, 2018
Session Name: Concurrent Session: The Guest That NEVER Leaves: Immunologic Challenges in Heart Transplantation
Session Time: 4:30pm-6:00pm
Presentation Time: 4:42pm-4:54pm
Location: Room 4C-3
Background: The impact of post-LVAD infections on allosensitization and heart transplantation (HT) is unknown. High levels of panel reactive antibodies (PRA) preclude HT but the influence of intermediate levels on allograft function and rejection has not been well studied.
Methods: Retrospective analysis of patients with LVADs who went onto cardiac transplant between 2009-2016. Per protocol, PRAs were determined by Luminex. Patients were divided with and without infection. cPRA(MFI>2000) was calculated within 3 months post-infection. Data on infections, PRA, biopsy and survival were gathered.
Results: Patient demographics and preoperative morbidities are comparable between the two groups. Prior to LVAD implantation sensitization was comparable. In contrast, 84% patients with infection became sensitized following infection vs non-infected group (26%). PRA levels increased after LVAD implantation in both groups, but the group with infection was significantly higher than the non-infected(16-84% vs 16%-26%). Importantly, patients with infections waited much longer for HT than those without infection, 555±426 days vs 299 ±318 days, p = <0.001. Rejection (R2) or four-year survival following HT was statistically equivalent between groups.
| With Infection | Without Infection | p-Value | |
| N=57 | N= 35 | N= 22 | Not significant |
| Age in years mean± SD | 50± 12.5 | 53± 14.7 | NS |
| Male% | 77 | 57 | 0.04 |
| BMI | 30.3 | 25.1 | NS |
| Diabetes% | 58 | 52 | NS |
| Hypertension% | 61 | 67 | NS |
| Pre-Op creatinine mg/dL | 1.27±0.5 | 1.2±0.47 | NS |
| Type of LVAD %
HeartMate II HeartWare |
86
14 |
66
33 |
0.02 |
| Blood transfusions % | 58 | 23 | 0.01 |
| Pre-LVAD
PRA > 10% cPRA (MFI>2000) |
16%
6% |
16%
16% |
0.9
0.1 |
| Post-LVAD
PRA > 10% cPRA (MFI > 2000) |
84%
58% |
26%
16% |
< 0.001
< 0.001 |
| Wait Time to Transplant | 555± 426 days | 299± 318 days | <0.001 |
| Donor Specific Antigen | 26% | 21% | NS |
| 4 Year Survival | 81% | 100% | 0.3 |
Conclusions: Infections in LVAD supported patients results in significant PRA development. Increased cPRA levels limit potential heart donors leading to longer wait times. While rejection and short-term survival was lower in the group with infection it did not attain statistical significant.
CITATION INFORMATION: Buto-Colletti C., Kimball P., Shah K., Quader M. Impact of Infections on Patients with Left Ventricle Assist Devices(LVAD): Allo-Sensitization and Heart Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Buto-Colletti C, Kimball P, Shah K, Quader M. Impact of Infections on Patients with Left Ventricle Assist Devices(LVAD): Allo-Sensitization and Heart Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/impact-of-infections-on-patients-with-left-ventricle-assist-deviceslvad-allo-sensitization-and-heart-transplantation/. Accessed October 25, 2020.« Back to 2018 American Transplant Congress