Post Heart Transplant Outcomes of Desensitized Durable Mechanical Circulatory Support Patients

J. Youn¹, D. Kim², J. Choi², K. Kim¹, I. Kim³, E. Kransdorf⁴, D. Chang⁴, M. Kittleson⁴, J. Patel⁴, R. Cole⁴, J. Moriguchi⁴, D. Ramzy⁵, F. Esmailian⁵, J. A. Kobashigawa⁴

¹Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea, Republic of, ²Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of, ³Keimyung University Dongsan Hospital, Daegu, Korea, Republic of, ⁴Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, ⁵Department of Cardiothoracic Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA

Meeting: 2022 American Transplant Congress

Abstract number: 144

Keywords: Heart/lung transplantation, Sensitization, Ventricular assist devices

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics I

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 5, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 6:10pm-6:20pm

Location: Hynes Room 210

*Purpose: Desensitization therapy (DST) is considered to increase the chances of a negative crossmatch, to expand the number of suitable donors, and to improve post-transplant outcomes. However, post-transplant outcome of consecutively enrolled desensitized durable mechanical circulatory support (MCS) patients are not well known. We aimed to investigate the post-transplant outcome of desensitized MCS patients.

*Methods: Among 689 consecutively enrolled heart transplant (HTx) recipients between 2010 and 2016, we categorized them into Group A (desensitized MCS patients, n = 21), Group B (desensitized non-MCS patients, n = 28) and Group C (all non-desensitized patients, n = 640). Post-transplant outcome included the incidence of primary graft dysfunction (PGD), 3-year survival, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), any treated rejection (ATR), acute cellular rejection (ACR), and antibody mediated rejection (AMR). Infectious complications were evaluated for Groups A and B.

*Results: The types of DST in both groups were similar and included combinations of rituximab/IVIG and plasmapheresis/bortezomib. Group A, compared with Group B, showed significantly higher pre-DST PRA (92.2 ± 9.8 vs. 83.3 ± 15.6, P = 0.007) and higher PRA reduction after DST (-22.2 ± 26.9 vs. -6.3 ± 7.5, P = 0.015). Groups A and C showed comparable PGD, 3-year survival, freedom from CAV, NF-MACE, ATR, ACR and AMR. Group A compared to Group B showed a numerically higher 3-year freedom from AMR. Infectious complications within 3 years were not different between Groups A and B.

*Conclusions: DST for MCS patients showed significant PRA reduction, resulting in an expansion of the donor pool. Post-transplant outcome of desensitized MCS patients showed comparable clinical outcome to all non-desensitized control patients in the same study period, revealing the safety and efficacy of DST.

To cite this abstract in AMA style:

Youn J, Kim D, Choi J, Kim K, Kim I, Kransdorf E, Chang D, Kittleson M, Patel J, Cole R, Moriguchi J, Ramzy D, Esmailian F, Kobashigawa JA. Post Heart Transplant Outcomes of Desensitized Durable Mechanical Circulatory Support Patients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/post-heart-transplant-outcomes-of-desensitized-durable-mechanical-circulatory-support-patients/. Accessed November 21, 2024.

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