*Purpose: Up to 30% of durable mechanical circulatory support (MCS) patients (pts) develop panel reactive antibody (PRA) screen >= 10%. In our program, desensitization (DS) is considered for pts with PRAs>50%. It has also been reported that sensitized MCS pts may have less humoral response post-transplant (HTx) following removal of the MCS device. We sought to investigate this observation in our sensitized MCS pts undergoing DS followed by HTx.

*Methods: Between 2010-16, 21 MCS pts who underwent DS were compared to a control group who underwent DS not on MCS support. PRAs were assessed at baseline and 2-4 weeks after DS. Post-HTx outcome included 3-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE), and freedom from rejection including any treated rejection (ATR), acute cellular rejection (ACR), and antibody-mediated rejection (AMR). Infection complications requiring IV antibiotics, history of septic shock and death due to infection within 3 years after HTx were also evaluated.

*Results: DS regimens in both groups were similar and included combinations of rituximab/IVIG and plasmapheresis/bortezomib. Desensitized MCS pts showed significantly higher baseline peak PRA (91.8% vs. 83.6%, p=0.046) and higher PRA reduction after DS (21.8% vs. 5.4%, p=0.022) compared with control group. Pts on MCS support appear to have numerically lower incidence of AMR with comparable three-year survival, freedom from CAV, NF-MACE, ATR and ACR. Infection complications within 3 years were not different between groups.

*Conclusions: DS for MCS pts showed significant PRA reduction, resulting in an expansion of their donor pool. Post-HTx outcome of desensitized MCS pts showed non-inferiority to desensitized non-MCS pts revealing good efficacy and safety of DS. Removal of the MCS device at the time of transplant may be related with potentially less AMR post-HTx.

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