There was a trend towards more females being present in the sensitized group as compared to the non-sensitized group. 257 48 days) and 1 year after HTX, there were no differences in rejection (total rejection score 0.30 vs. 0.37) and survival (93% ZM323881 vs. 88%). Conclusion Allosensitization after LVAD is usually common despite cytotoxic PRA being negative. One year after HTX, this sensitization does not translate into increased acute cellular or antibody mediated rejection or reduced survival. Keywords: Heart transplant, HLA, single bead antigen assay, left ventricular assist device Introduction Left ventricular assist devices (LVAD) are progressively being used as a bridge to heart transplantation (BTT). In 2009 2009, for the first time, over 30% of heart transplant recipients were bridged with mechanical circulatory support1. However, one of the proposed limitations of LVAD therapy is the higher degree of sensitization prevalent in these patients 2. Patients who are sensitized to foreign human leucocyte antigens (HLA) and await heart transplantation HTX) have a longer waiting time around the HTX list ZM323881 than non-sensitized patients 3. Despite numerous immunosuppression strategies targeting sensitized patients, the efficacy of these approaches appear to be limited, rendering desensitization as a procedure of limited opportunity for these unfortunate patients4. Furthermore after HTX, the sensitized recipient is at an increased risk for rejection and has inferior survival,5. Historically, LVAD associated sensitization has been characterized by overall performance and measurement of panel reactive antibodies (PRA) ZM323881 based on a match dependent cytotoxicity (CDC) assay, a technique that is neither specific nor sensitive for anti-HLA antibodies. Therefore, ZM323881 many transplant centers are progressively using more sensitive techniques like single antigen bead (SAB) assays to assess degree of sensitization in potential HTX recipients4. It is now common practice to obtain anti-HLA antibody (Abs) information by using SAB in potential HTX recipients for the purposes of determining transplant eligibility, listing unacceptable antigens and determining suitability of donors. LVAD implant is also being recommended to bridge sensitized patients to transplant. However, to date there has been no data published on whether sensitization as measured by this newer technology occurs with continuous axial circulation LVAD implantation in the adult populace. The purpose of this study was to assess the impact of LVAD implant on sensitization as measured by SAB assays and to correlate sensitization, if it occurs, with clinical outcomes in BTT LVAD recipients. Methods The study was performed at Mayo Medical center, Rochester and was approved by the institutional review table. Patient population A total of 30 consecutive HTX recipients who underwent continuous axial circulation LVAD implants as a BTT were included in this study. All clinical and demographic data at baseline, before and after LVAD implant and after HTX was retrieved from your electronic medical record. Main immunosuppressive brokers (calcineurin inhibitors or sirolimus), and secondary immunosuppressive brokers mycophenolate mofetil (MMF) or azathioprine, and dose of prednisone was not modified based on the presence or absence of donor specific antibodies (DSA). All HTX recipients received induction therapy with monoclonal antibody against CD3 (OKT3) or antithymocyte globulin (ATG), as part of a standard induction protocol. Patients with a positive circulation crossmatch assay underwent plasmapheresis immediately after HTX for 5 days. Total rejection score was calculated for each patient as explained before 6. Antibody mediated rejection was defined as per standard ISHLT criteria and reported as AMR 1 or 0. Anti-HLA antibody characterization Mouse monoclonal to CD40 Anti-HLA antibody levels were quantified using a combination of cell-based and solid-phase assays. HLA-Abs were measured prior to and after LVAD implantation and at the.
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