Cardiac allograft rejection in the current era of continuous flow left ventricular assist devices

Commentary: Absence of ventricular assist device–related risk for rejection after heart transplantation: Good news given the “new normal”

“…4 The similar low incidence of sensitization at transplant among those with and without LVAD support is important, given the much longer wait times among the patients with LVAD and the mean support time of more than a year. 1 These findings will help reassure the LVAD/transplant teams of the relative safety (in terms of sensitization) of prolonged waitlist time for LVAD patients in this "new normal" of reduced priority of patients with LVADs under the current United Network of Organ Sharing allocation algorithm.…”

“…During the era before 2008 (the first Food and Drug Administration approval of a CF LVAD), sensitization possibly stimulated by the textured blood interface of the XVE 2 generated intense interest from the heart transplant community because of the perceived increased challenges of identifying suitable donors and because of the association between sensitization and worse rejection-related outcomes after transplant. 3 Bakir and colleagues 1 have demonstrated again that with current-era devices, such concerns have become largely neutralized. Of course, the finding of markedly reduced tendency for developing anti-HLA antibodies with CF LVADs is not new.…”

Commentary: The anticlimax of the left ventricular assist devices–associated antibodies

“…9 Inevitably, the allosensitization consequences need a treatment approach guided by knowledge of outcomes. The study by Bakir and colleagues 6 is adding to our emerging understanding of the role of antibodies in LVAD-bridged HT recipients, and we sincerely applaud them for their contribution to this field.…”

“…In this issue of the Journal, Bakir and colleagues 6 investigate acute cellular rejection (ACR) incidence in a propensity-matched cohort of patients who had undergone HT with or without LVAD support at a single center. The authors report no difference in moderate-to-severe histologic ACR rates between the 2 groups at 12 and 24 months post-HT, consistent with previous reports.…”

Commentary: Fear of rejection: Acute cellular rejection after ventricular assist device placement

“…Bakir and colleagues 7 retrospectively reviewed allograft rejection in their patients undergoing transplantation bridged from continuous-flow LVAD therapy. They propensity matched their cohort of LVAD patients to patients primarily transplanted without mechanical support bridge and modeled predictors of acute cellular rejection.…”