Lack of significant de novo HLA allosensitization in ventricular assist device recipients transfused with leukoreduced, ABO identical blood products

Abstract

Ventricular assist devices provide support for a failing heart and often serve as a bridge to transplantation. The use of these devices has also been associated with allosensitization to HLA antigens because of transfusion of blood products. Our program established a protocol mandating the use of leukoreduced, irradiated and ABO identical products, including platelets, in patients receiving initial implantations of VAD as a bridge to transplantation. Recipients were tested for anti-HLA antibodies before VAD implantation and monthly postimplantation by cytotoxicity and solid phase assays. We observed minimal de novo anti-HLA sensitization (<10%) in this population of 55 patients, each receiving a mean of 90 blood components, using this approach. No patient developed broad sensitization (PRA>50%). In conclusion, The use of leukoreduced, irradiated, ABO identical blood products abrogates broad allosensitization in this highly transfused population.

An Old Problem with a New Therapy

“…During the work-up phase, patients receive multiple transfusions that increase the risk of antibody development and can affect the ability of the patient to receive a future heart transplant. 16 Most importantly, despite recent improvements in technology, the traditional algorithms we use to treat GIB were primarily designed for the general population and are not specific for VAD patients. Technology has seen many improvements during the last decade, especially when examining the small bowel.…”

Allosensitization and the Ventricular Assist Device: Dual Evolution of Technology

“…The positive reactions converted to negative when sera were pre-incubated with albumin-coated beads. Similarly, serum from VAD patients tested in our laboratory [12] exhibited reactivity in ELISA assays, but reactivity occurs even in wells that do not contain HLA antigen, indicating false positive reactions.…”

“…The same group [11] later presented a larger cohort of HeartMate recipient (n=71) analyzing the effect of leuko-reduced blood products, but found no significant effect. Our laboratory [12] reported a series of 55 VAD recipients, most of whom had received a pulsatile device. Our center only uses leuko-reduced, irradiated, and ABO matched blood products and we observed minimal allosensitization.…”

Providing ABO‐identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

“…This low incidence of refractoriness is likely due to our protocol that from 1990 onward mandated transfusion of only leukoreduced, ABO identical platelets for all patients at high risk of platelet transfusion refractoriness. 4,7–9 …”

“…7,8 Cardiac surgery patients with a ventricular assist device receiving only leukoreduced, ABO identical transfusions have a reduced risk of HLA-A,B allosensitization in one observational study. 9 A retrospective, observational cohort study of cardiac surgical patients demonstrated that patients receiving only ABO identical platelets had fewer red cell and platelet transfusions, a shorter length of hospital stay, fewer days of postoperative fever, fewer days on antibiotics, fewer hours in the ICU, one third the in-hospital mortality, and lower hospital costs and charges when compared to patients receiving ABO non-identical platelets. 10 Transfusion of ABO non-identical components, in preliminary reports, has been associated with an increase in red cell transfusions in blunt trauma patients 11 and in surgical patients overall.…”