ORIGINAL ARTICLE

Outcomes after heart transplantation in sensitized patients bridged with ventricular assist devices

Corresponding Author

Charles D. Fraser III MD

[email protected]

orcid.org/0000-0003-4761-3296

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Correspondence Charles D. Fraser, MD, Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, 1800 Orleans Str, Zayed Tower 7107, Baltimore, MD 21287. Email: [email protected]

Search for more papers by this author

Xun Zhou MD,

Xun Zhou MD

orcid.org/0000-0001-5179-5032

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

J. Trent Magruder MD,

J. Trent Magruder MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Alejandro Suarez-Pierre MD,

Alejandro Suarez-Pierre MD

orcid.org/0000-0003-1821-6240

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Cecillia Lui MD,

Cecillia Lui MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Joshua C. Grimm MD,

Joshua C. Grimm MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Robert Higgins MD,

Robert Higgins MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Ahmet Kilic MD,

Ahmet Kilic MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Charles D. Fraser III MD,

Corresponding Author

Charles D. Fraser III MD

[email protected]

orcid.org/0000-0003-4761-3296

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Xun Zhou MD,

Xun Zhou MD

orcid.org/0000-0001-5179-5032

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

J. Trent Magruder MD,

J. Trent Magruder MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Alejandro Suarez-Pierre MD,

Alejandro Suarez-Pierre MD

orcid.org/0000-0003-1821-6240

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Cecillia Lui MD,

Cecillia Lui MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Joshua C. Grimm MD,

Joshua C. Grimm MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Robert Higgins MD,

Robert Higgins MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

Ahmet Kilic MD,

Ahmet Kilic MD

Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Search for more papers by this author

First published: 02 May 2019

https://doi.org/10.1111/jocs.14066

Citations: 10

This study was presented at the 38th annual meeting of the International Society for Heart and Lung Transplantation, 8 April 2018, Nice, France.

Share a link

Email
Wechat
Bluesky

Abstract

Objective

Sensitization has been associated with worse outcomes following heart transplantation (HTx). The use of ventricular assist devices (VAD) is a risk factor for the development of sensitization. We investigated the impact of left ventricular assist devices (LVAD) and sensitization in HTx recipients.

Methods

We queried the UNOS database for all heart transplants performed from January 2000 through December 2016. Patients were considered highly sensitized and included if panel-reactive antibody (PRA) activity was 25% or higher. Patients were separated by pretransplant LVAD utilization and subgroup analysis was performed by device type (HeartMate II or HeartWare). Outcomes included Kaplan-Meier survival and episodes of rejection within 1 year of HTx.

Results

Of 18 009 recipients, 2434 (14%) were highly sensitized. 1055 (43.3%) were bridged with a VAD. In multivariate analysis, LVAD use did not impact 1-year (hazards ratio [HR], 1.30; P = 0.052) or 5-year survival (HR, 1.18; P = 0.112) in highly sensitized recipients. Furthermore, episodes of rejection were not affected by LVAD status (P = 0.765). Of the 1055 sensitized LVAD-bridged transplant recipients, 624 (59%) were implanted with a HeartMate II and 99 (9.4%) were bridged with a HeartWare device. In multivariate analysis, no differences were observed in 1-year survival (HR, 0.86; P = 0.664), 5-year survival (HR, 1.35; P = 0.209), or episodes of rejection (P = 0.497).

Conclusions

The use of ventricular assist devices did not impact survival or rejection within 1 year of HTx in highly sensitized patients. Highly sensitized recipients have similar outcomes regardless of prior LVAD support or type of LVAD used as a bridge to transplantation.

CONFLICT OF INTERESTS

The authors declare that there are no conflict of interests.

Supporting Information

REFERENCES

1Ko B-S, Drakos S, Kfoury AG, et al. Immunologic effects of continuous-flow left ventricular assist devices before and after heart transplant. J Heart Lung Transplant. 2016; 35(8): 1024-1030. https://doi.org/10.1016/j.healun.2016.05.001
10.1016/j.healun.2016.05.001
PubMed Web of Science® Google Scholar
2Kobashigawa J, Tadwalkar R, Kittleson M, et al. Establishing a PRA threshold to treat sensitized patients awaiting heart transplant in the era of the virtual crossmatch. J Heart Lung Transplant. 2013; 32(4): S53. https://doi.org/10.1016/j.healun.2013.01.942
10.1016/j.healun.2013.01.942
Web of Science® Google Scholar
3Drakos SG, Kfoury AG, Kotter JR, et al. Prior human leukocyte antigen-allosensitization and left ventricular assist device type affect degree of post-implantation human leukocyte antigen-allosensitization. J Heart Lung Transplant. 2009; 28(8): 838-842. https://doi.org/10.1016/J.HEALUN.2009.04.031
10.1016/j.healun.2009.04.031
PubMed Web of Science® Google Scholar
4Massad MG, Cook DJ, Schmitt SK, et al. Factors influencing HLA sensitization in implantable LVAD recipients. Ann Thorac Surg. 1997; 64(4): 1120-1125. https://doi.org/10.1016/S0003-4975(97)00807-2
10.1016/S0003-4975(97)00807-2
CAS PubMed Web of Science® Google Scholar
5Arnaoutakis GJ, George TJ, Kilic A, et al. Effect of sensitization in US heart transplant recipients bridged with a ventricular assist device: update in a modern cohort. J Thorac Cardiovasc Surg. 2011; 142(5): 1236-1245. https://doi.org/10.1016/j.jtcvs.2011.07.019
10.1016/j.jtcvs.2011.07.019
PubMed Web of Science® Google Scholar
6Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007; 357(9): 885-896. https://doi.org/10.1056/NEJMoa067758
10.1056/NEJMoa067758
CAS PubMed Web of Science® Google Scholar
7Clarke B, Ducharme A, Giannetti N, et al. Multicenter evaluation of a national organ sharing policy for highly sensitized patients listed for heart transplantation in Canada. J Heart Lung Transplant. 2017; 36(5): 491-498. https://doi.org/10.1016/j.healun.2017.01.003
10.1016/j.healun.2017.01.003
PubMed Web of Science® Google Scholar
8Bull DA, Reid BB, Selzman CH, et al. The impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation. J Thorac Cardiovasc Surg. 2010; 140(1): 169-173. https://doi.org/10.1016/J.JTCVS.2010.03.026
10.1016/j.jtcvs.2010.03.026
PubMed Web of Science® Google Scholar
9Johnson JT, Eckhauser AW, Pinto NM, Weng H-Y, Minich LL, Tani LY. Indications for intervention in asymptomatic children with chronic mitral regurgitation. Pediatr Cardiol. 2015; 36(2): 417-422. https://doi.org/10.1007/s00246-014-1026-z
10.1007/s00246-014-1026-z
PubMed Web of Science® Google Scholar
10Nwakanma LU, Williams JA, Weiss ES, Russell SD, Baumgartner WA, Conte JV. Influence of pretransplant panel-reactive antibody on outcomes in 8,160 heart transplant recipients in recent era. Ann Thorac Surg. 2007; 84(5): 1556-1563. https://doi.org/10.1016/J.ATHORACSUR.2007.05.095
10.1016/j.athoracsur.2007.05.095
PubMed Web of Science® Google Scholar
11Jacobs JP, Quintessenza JA, Boucek RJ, et al. Pediatric cardiac transplantation in children with high panel reactive antibody. Ann Thorac Surg. 2004; 78(5): 1703-1709. https://doi.org/10.1016/J.ATHORACSUR.2004.03.031
10.1016/j.athoracsur.2004.03.031
PubMed Web of Science® Google Scholar
12Kidambi S, Mohamedali B, Bhat G. Clinical outcomes in sensitized heart transplant patients bridged with ventricular assist devices. Clin Transplant. 2015; 29(6): 499-505. https://doi.org/10.1111/ctr.12540
10.1111/ctr.12540
CAS PubMed Web of Science® Google Scholar
13Joyce DL, Southard RE, Torre-Amione G, Noon GP, Land GA, Loebe M. Impact of left venticular assist device (LVAD)-mediated humoral sensitization on post-transplant outcomes. J Heart Lung Transplant. 2005; 24(12): 2054-2059. https://doi.org/10.1016/J.HEALUN.2005.06.028
10.1016/j.healun.2005.06.028
PubMed Web of Science® Google Scholar
14See SB, Clerkin KJ, Kennel PJ, et al. Ventricular assist device elicits serum natural IgG that correlates with the development of primary graft dysfunction following heart transplantation. J Heart Lung Transplant. 2017; 36(8): 862-870. https://doi.org/10.1016/j.healun.2017.03.018
10.1016/j.healun.2017.03.018
PubMed Web of Science® Google Scholar
15Smith JD, Danskine AJ, Laylor RM, Rose ML, Yacoub MH. The effect of panel reactive antibodies and the donor specific crossmatch on graft survival after heart and heart-lung transplantation. Transpl Immunol. 1993; 1(1): 60-65. https://doi.org/10.1016/0966-3274(93)90060-L
10.1016/0966-3274(93)90060-L
CAS PubMed Google Scholar
16Chih S, Patel J. Desensitization strategies in adult heart transplantation—Will persistence pay off? J Heart Lung Transplant. 2016; 35(8): 962-972. https://doi.org/10.1016/j.healun.2016.03.021
10.1016/j.healun.2016.03.021
PubMed Web of Science® Google Scholar

Citing Literature

All articles

Outcomes after heart transplantation in sensitized patients bridged with ventricular assist devices

Abstract

Objective

Methods

Results

Conclusions

CONFLICT OF INTERESTS

Supporting Information

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Outcomes after heart transplantation in sensitized patients bridged with ventricular assist devices

Abstract

Objective

Methods

Results

Conclusions

CONFLICT OF INTERESTS

Supporting Information

REFERENCES

Citing Literature

References

Related

Information