LVAD treated heart recipients do not have deleterious HLA antibody

Relationship between bridging with ventricular assist device on rejection after heart transplantation

“…7 And in yet another study, rejection rates were significantly lower in LVAD-bridged recipients than in patients who did not require mechanical support before heart transplantation. 3 Although PRA Ն10% has been previously identified as a risk factor for rejection after transplantation, it is possible that improved immunosuppression strategies have reduced the risk of rejection associated with preoperative sensitization. 8 In the most recent report of the ISHLT, PRA Ͼ10% was found to be a significant risk factor for 1-year mortality after adult heart transplant in the years 1995 to 1998 (odds ratio 1.25, p ϭ 0.03), but not from 1999 to June 2001 (odds ratio 1.26, p ϭ 0.1).…”

“…The percentage of patients, previously unsensitized, who develop anti-HLA antibodies during VAD support ranges from 14% to 66% in different series. 1,[3][4][5][6][7] The significance of this after transplantation is less clear. It has been demonstrated that an elevated PRA results in reduced long-term survival and increased incidence of acute and chronic rejection after transplantation, with the threshold for sensitization being a PRA of more than 10% in one landmark study 8 and more than 25% in another.…”

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

“…The implantation of certain assist devices has been associated with many systemic irregularities including defects in coagulation and fibrinolysis cascades, infections (bacterial and fungal), decreased and TH-2 skewed T-cell responses, increased B-cell numbers and production of IgG, and higher serum levels of inflammatory molecules [3-6]. Implantation has also been associated with allosensitization to HLA antigens, presumably due to transfused blood products [7-10], although some reports have suggested alternative mechanisms [11-13]. Allosensitization may greatly increase the wait time for a compatible graft, and the odds of an antibody-mediated rejection episode after transplantation.…”