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Impact of Infections on Patients with Left Ventricle Assist Devices(LVAD): Allo-Sensitization and Heart Transplantation

C. Buto-Colletti, P. Kimball, K. Shah, M. Quader.

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

Related Abstracts
  • Impact of Implantation of Ventricular Assist Devices on the Incidence of Post-Transplant Infections in Heart Transplant Recipients
  • Pulmonary Vascular Hemodynamics Improvement with Left Ventricular Assist Devices Unloading Is Sustained after Heart Transplantation

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 InfectionWithout Infectionp-Value
N=57N= 35N= 22Not significant
Age in years mean± SD50± 12.553± 14.7NS
Male%77570.04
BMI30.325.1NS
Diabetes%5852NS
Hypertension%6167NS
Pre-Op creatinine mg/dL1.27±0.51.2±0.47NS
Type of LVAD %

HeartMate II

HeartWare

86

14

66

33

0.02
Blood transfusions %58230.01
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 Transplant555± 426 days299± 318 days<0.001
Donor Specific Antigen26%21%NS
4 Year Survival81%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).

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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 February 23, 2019.

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