Objectives: The true relevance of allosensitization in patients benefiting from left ventricular assist device (LVAD) as bridge to transplant (BTT) is still debated. Registry data includes a variety of devices which does not allow for LVAD-specific analysis. We studied a homogeneous group of patients with Novacor LVAD devices prior to transplantation
Methods: From 1994 to 2006, 37 Novacor LVADs were implanted as BTT, with 30 patients surviving to transplantation (81%). After PRA screening by complement-dependent cytotoxicity assay, post-VAD sensitization was determined for anti-HLA Class I and Class II IgGs. Study end-points were overall survival, acute cellular rejection and chronic allograft vasculopathy (CAV). The results from VAD patients were compared to non-VAD primary transplant recipients (n=324).
Results: Five out of 23 patients available for analysis developed PRAs after VAD insertion (21.7%). The mean PRA values after Novacor VAD implantation was 11% [3-100%]. Mean time to follow-up was 46 and 90 months for VAD and non-VAD patients (p<.001). Actuarial survival at 3, 5 and 10 years for VAD and non-VAD transplant recipients was 79%, 73% and 55%; and 77%, 71% and 56%, respectively (p=NS). Diagnosis of any acute cellular rejection ³ 3A was present in 23.3% (VAD group) and 22.7% (non-VAD group) (p=NS). At last follow-up for survivors, respective incidence of CAV was 8% (VAD group) and 26.4% (non-VAD group) (p<.05).
Conclusions: In this study, allosensitization occurred infrequently after Novacor LVAD implantation. Secondly, analysis of outcome variables shows that BTT patients can anticipate similar survival to non-BTT patients, thus minimizing the impact of allosensitization after LVAD implantation
Allosensitization in Bridge to Transplant Novacor LVAD patients: Analysis of long-term outcomes with regard to acute rejection and chron. allograft vasculopathyTimmermans T, Vancaeneghem O, Gurne O, Noirhomme Ph, Jacquet L, Latinne D, Poncelet AJ
Cliniques Universitaires Saint-Luc, Bruxelles |