Purpose: Sensitization prior to heart transplantation (HTx) has been associated with increased mortality and rates of rejection as well as an increased incidence of cardiac allograft vasculopathy (CAV). Patients with risk factors including prior pregnancies, blood transfusions or transplants have the potential to become allosensitized. Research has also shown that mechanical circulatory support (MCS) devices can induce sensitization via antibody production. We sought to assess whether MCS patients that were desensitized before heart transplantation had improved outcome after transplantation.

Methods: Between 2010 and 2015, we assessed 54 patients implanted with an MCS device prior to HTx with a pre-transplant panel reactive antibody (PRA) ≥ 10%. Of these, 30 patients (55.6%) received desensitization therapies prior to heart transplantation (i.e. IVIG, rituximab, bortezomib, and plasmapheresis). Endpoints included 2-year survival, 2-year freedom from CAV (defined by ≥ 30% angiographic stenosis), 2-year freedom from any-treated rejection (ATR), acute cellular rejection (ACR), and antibody mediated rejection (AMR).

Results: There were 34/54 (63.0%) LVADs, 9/54 (16.7%) BiVADs, and 11/54 (20.4%) TAHs in the sensitized MCS population. The most common mode of desensitization pre-transplant was IVIG (66.7%, 20/30). There was no significant difference in 2-year survival, freedom from CAV, ATR, ACR, or AMR between the two groups.

Conclusion: MCS patients with a pre-transplant PRA ≥ 10% who were desensitized have comparable outcome to MCS patients with an elevated PRA who were not desensitized.

CITATION INFORMATION: Kobashigawa J., Patel J., Kransdorf E., Dimbil S., Levine R., Passano E., Czer L., Moriguchi J., Arabia F. MCS and Desensitization Am J Transplant. 2017;17 (suppl 3).

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