Ventricular assist device (VAD) is implicated in HLA-sensitization. We investigate the association between VAD and HLA & MICA sensitization.
Of all VAD patients studied (00-09); 89 had pre-VAD antibody testing and another in 6 months post-VAD. A non-VAD group of transplant candidates were included for comparison.; 2 randomly selected/VAD patient matched for year of initial PRA.
Follow-up was longer in non-VADs to increase capturing non-VAD PRA increases (53 vs. 28 days, p=0.001). VAD was associated with significant increase in both peak & difference between peak and initial PRA (Table 1).The number of transfusion was higher in the VAD cases (15 vs. 2, p<0.0001).
|VAD n = 89||non VAD n = 178||p|
|Peak PRA CLI %||24 (7 – 72)||6 (2 – 26)||<.001|
|Diff in PRA CL I, %||18 (3 – 52)||0 (0 – 1)||<.001|
|Peak PRA CL II %||4 (1 -16)||2 (1 – 5)||0.04|
|Diff in PRA CL II, %||2 (0 -13)||0 (0 – 0)||0.0001|
Of patients who had single antigen Luminex testing done, VAD implantation was significantly associated with development of new HLA antibody specificities post-VAD with increase in cPRA post-VAD compared to non-VAD group (16 vs. 0 %, p<0.0001). Pulsatile devices compared to continuous flow devices were significantly associated with a higher peak class II PRA (8 vs. 2, p=0.003) and difference in class II PRA (5 vs. 1%, p=0.002), but not class I PRA. Multivariable models were made to adjust for pre-VAD PRA, gender, age, transfusion, and duration of follow-up where the VAD and differences in class I and II PRA associations remained. MICA allosensitization was comparable among both groups (14%). There was no significant difference in the incidence of positive T cell crossmatch, pre-transplant and de novo DSA rejection episodes or graft survival among the 2 groups (Figure 1).
VAD is associated with HLA sensitization independent of other risk factors. It was not significantly associated with differences in rejection or allograft survival, but may represent a barrier to transplant by limiting donors and lengthening of wait time.
To cite this abstract in AMA style:Askar M, Hsich E, Reville P, Daghstani J, Nowacki A, Bakdash S, Zhang A, Klingman L, Baldwin W, Smedira N, Taylor D, Starling R, Gonzalez-Stawinski G. Ventricular Assist Devices Are Associated with HLA but NOT MICA Allosensitization [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/ventricular-assist-devices-are-associated-with-hla-but-not-mica-allosensitization/. Accessed October 30, 2020.
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