Comparison of HLA & MICA Allosensitization Patterns among Patients Supported by Ventricular Assist Devices (VAD) and Patients with No Devices

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• 作者：M. Askar¹ ; E. Hsich² ; P. Reville¹ ; J. Daghstani¹ ; A. Nowacki³ ; A. Zhang¹ ; L. Klingman¹ ; S. Bakdash⁴ ; W. Baldwin⁵ ; N. Smedira⁶ ; D. Taylor² ; R. Starling² ; G. Gonzalez-Stawinski⁷
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：32
• 期：4_supp_S
• 页码：S74
• 全文大小：138 K

文摘

| Figures/TablesFigures/Tables

Purpose

Ventricular assist device (VAD) is implicated in HLA-sensitization. We investigate the association between VAD and HLA & MICA sensitization.

Methods and Materials

Of VAD patients in our institute (00-09); 89 had pre-VAD antibody testing and another in 6 months post-VAD. The comparison group was no-VAD heart transplant candidates; 2 randomly selected/VAD patient matched for year of initial PRA.

Results

Follow-up was longer in the non-VADs to increase capturing non-VAD increases in PRA (53 vs. 28 days, p=0.001). The number of transfusions was higher in VADs (15 vs. 2), p<0.0001). VAD was associated with significant increase in both peak & difference between peak and initial PRA (). In patients with single antigen testing, VAD was associated with new HLA antibody specificities and increased cPRA (16 (0-41) % vs. 0 % , p<0.0001). Pulsatile compared to continuous flow VADs were significantly associated with a higher class II peak and difference but not class I PRA. Multivariable models to adjust for pre-VAD PRA, gender, age, transfusion, and duration of follow-up and the associations remained. MICA allosensitization was comparable among both groups (14 % ). There was no significant difference in the incidence of positive crossmatch, de novo DSA, rejection or survival ().

Conclusions

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.

Table 1
	VAD	nonVAD	p
Class I Pk %	24 (7-72)	6 (2-26)	<.0001
Class I Diff	18 (3-52)	0 (0-1)	<.0001
Class II Pk %	4 (1-16)	2 (1-5)	.04
Class II Diff	2 (0-13)	0	.0001