Natural Antibodies and Left Ventricular Assist Device Complications

S. B. See¹, A. Pinsino², R. Shihab¹, N. Kunimune¹, D. Onat², E. Hittesdorf³, A. R. Garan², V. K. Topkara², Y. Naka⁴, H. Takayama⁴, K. Takeda⁴, P. Colombo², M. Yuzefpolskaya², G. Wagener³, E. Zorn¹

¹Columbia Center for Translational Immunology, Columbia University, New York, NY, ²Division of Cardiology, Columbia University, New York, NY, ³Department of Anesthesiology, Columbia University, New York, NY, ⁴Department of Surgery, Columbia University, New York, NY

Meeting: 2019 American Transplant Congress

Abstract number: A40

Keywords: Antibodies, Ventricular assist devices

Session Information

Session Name: Poster Session A: B-cell / Antibody /Autoimmunity

Session Type: Poster Session

Date: Saturday, June 1, 2019

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

*Purpose: Left ventricular assist devices (LVAD) are used as a bridge to heart transplantation or destination therapy for advanced heart failure. For all its benefits, LVAD are associated with hemocompatibility-related complications such as pump thrombosis, stroke and bleeding. We previously reported that LVAD implantation is followed by a sharp increase in serum IgG natural antibodies (Nabs) recognizing oxidation-specific epitopes (OSE). Nabs have been implicated in inflammatory reactions related to atherosclerosis, ischemic stroke and primary graft dysfunction following heart transplantation but their consequences following LVAD is unknown. We hypothesized that post-implant Nabs may contribute to LVAD complications by modulating the coagulation cascade.

*Methods: We studied a cohort of 31 adult patients who received a continuous flow LVAD (22 Heartmate II, 9 Heartmate 3) at Columbia University/NewYork Presbyterian Hospital. Nabs and anti-phospholipid antibodies (aPL) were measured in longitudinal pre- and post-LVAD sera by assessing IgG reactivity to the OSE malondialdehyde (MDA) or β2-glycoprotein complexes by ELISA. In a subset of patients, Nabs were measured at day 1-7 post-implant. The effect of IgG Nabs on hemostasis was tested by rotational thromboelastometry (ROTEM) by adding pre- and post-LVAD IgG to ABO-matched donor blood.

*Results: Mean IgG Nabs levels were significantly increased in post-LVAD sera at 1 (1760±420 units/mL, p<0.0001), 6 (3735±478 units/mL, p<0.0001) and 12 months (3753±613 units/mL, p<0.0001) compared to pre-LVAD (273±64 units/mL). Nabs could be detected above baseline by day 7. No differences were observed for aPL. The addition of Nabs from post-LVAD serum increased the clotting time of healthy blood (296.7±56.5 vs 180.3±50.3 s, p<0.05).

*Conclusions: Our studies revealed that serum IgG Nabs to OSE are elevated following LVAD implant but was not accompanied by aPL increase. IgG Nabs prolonged the clotting time of donor whole blood, suggesting that Nabs modulate the coagulation pathway. These findings suggest that IgG Nabs may contribute to hemocompatibility-related complications in LVAD recipients.

To cite this abstract in AMA style:

See SB, Pinsino A, Shihab R, Kunimune N, Onat D, Hittesdorf E, Garan AR, Topkara VK, Naka Y, Takayama H, Takeda K, Colombo P, Yuzefpolskaya M, Wagener G, Zorn E. Natural Antibodies and Left Ventricular Assist Device Complications [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/natural-antibodies-and-left-ventricular-assist-device-complications/. Accessed November 21, 2024.

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