Early and Late Rejection and HLA Sensitization at the Time of Heart Transplantation in Patients Bridged With Left Ventricular Assist Devices

Over the years, the frequency of heart transplant candidates with HLA sensitization has increased as a result of the number of patients bridged to transplant using left ventricular assist devices (LVAD). Here we have examined 119 patients who were bridged to transplant with LVAD for a relationship b...

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Bibliographic Details
Published in:Transplantation proceedings 2005-03, Vol.37 (2), p.1349-1351
Main Authors: Gonzalez-Stawinski, G.V., Atik, F.A., McCarthy, P.M., Roselli, E.E., Hoercher, K., Navia, J.L., Smedira, N.G., Starling, R.C., Young, J.B., Cook, D.J.
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Flow Cytometry
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft Rejection - epidemiology
Graft Rejection - immunology
Heart Diseases - surgery
Heart Diseases - therapy
Heart Transplantation - immunology
Heart-Assist Devices
Histocompatibility Antigens Class I - immunology
Histocompatibility Testing
HLA Antigens - immunology
Humans
Intensive care medicine
Isoantibodies - blood
Medical sciences
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tissue, organ and graft immunology
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Summary:Over the years, the frequency of heart transplant candidates with HLA sensitization has increased as a result of the number of patients bridged to transplant using left ventricular assist devices (LVAD). Here we have examined 119 patients who were bridged to transplant with LVAD for a relationship between HLA antibodies and early (30 days) and late (2 years or more) rejection, as evidenced by endomyocardial biopsies. Both cytotoxic panel–reactive antibody reactions against a panel of T lymphocytes (T-PRA) and the percentage of transplants that occurred across a positive class I flow cross-match were examined. Biopsies were scored using ISHLT criteria. At 30 days, patients who had a biopsy grade of 0 had a mean T-PRA at transplant of 2.2%, while the mean PRAs of the other biopsy grades were significantly higher ( P < .001). A similar pattern was seen with the highest biopsy results at 2 years or later ( P < .001). None of the patients who had a grade 0 biopsy at 30 days posttransplant had a positive flow cytometry class I cross-match ( P = .02), although the same pattern did not occur later due to a small number of patients (n = 3) who had negative biopsies. Thus, when biopsy results were examined early or late posttransplant, patients with negative biopsy results tended to have less HLA sensitization. While the methods of HLA sensitization involve humoral responses, more aggressive immunosupression might be warranted to attempt to reduce cellular rejection posttransplant if HLA class I antibodies are present at the time of transplant.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2004.12.111