Date: Sunday, June 2, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Room 206
*Purpose: Left ventricular assist devices (LVAD) are made of biomaterials that have been shown to cause allosensitization. Single center studies have suggested that patients bridged to transplant with an LVAD may be at a higher risk for allograft rejection after cardiac transplant.
*Methods: We queried the United Network for Organ Sharing (UNOS) dataset for all heart transplant recipients between 1/2010 to 1/2016. Patients were categorized according to the presence of an LVAD (e.g. HeartMate II or HeartWare HVAD) prior to transplant. Patients with other types of mechanical circulatory support were excluded from the analysis. The incidence of all-cause (cellular and antibody mediated) rejection within the 1st year after transplant was compared. Logistic regression was used to examine the odds of rejection, within a year after transplant, and death in patients with rejection.
*Results: Our study population included 9,847 transplant recipients (Table). The LVAD and Non-LVAD groups were notably different in sex composition, health insurance and infection requiring IV antibiotics. LVAD patients were more likely to receive blood products between listing and transplant (42.3 v. 8.1 transfusions, p<0.001) and more commonly had a panel reactive antibodies > 25% for Class I antigens (14% v. 11.6%, p < 0.001). Incidence of acute rejection one year after heart transplant was similar among LVAD (18.2%) and Non-LVAD patients (17.3%, p = 0.19). In unadjusted [OR: 1.05, 95% CI: 0.95-1.16] and adjusted analyses [OR: 1.12, 95% CI: 0.99-1.27], the odds of acute rejection one-year after transplant was similar among LVAD and non-LVAD patients. Incidence of acute rejection one year after transplant was similar across LVAD types (HeartMate II 18.1%, HVAD 18.6%, OR: 1.10, 95% CI: 0.96-1.25). Finally one-year survival in patients with rejection was similar in patients with (10.9%) and without (11.9%) an LVAD, p = 0.49.
*Conclusions: In this UNOS analysis, despite higher rates of blood transfusion and PRA pre-transplant, there were no significant differences in acute rejection within one-year after transplant among patients bridged to transplant with an LVAD. These findings suggest that induction and immunosuppression strategies for LVAD patients can mirror other cardiac transplant populations.
To cite this abstract in AMA style:Patel RC, Cooper LB, Barnett SD, Cole RT, Psotka MA, Cochrane A, Sinha S, Bogar LJ, Desai SS, Shah P. Incidence and Risk of Allograft Rejection after Cardiac Transplantation in Left Ventricular Assist Device Patients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-and-risk-of-allograft-rejection-after-cardiac-transplantation-in-left-ventricular-assist-device-patients/. Accessed December 3, 2020.
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