Ventricular Assist Devices and Aggressive Immunosuppression: Looking Beyond Overall Survival

One hundred days or more bridged on a ventricular assist device and effects on outcomes following heart transplantation☆

“…The incidence of HLA mismatch !4 antigens was increased in the patients that died from CAV when compared to the general population, but the degree of sensitization at the time of transplant, as indicated by PRA measurements and desensitization strategies (Table 1 and data not shown), was comparable. It is known that implantation of an LVAD increases humoral sensitization; however, there appears to be no association between LVAD implantation and negative events such as rejection and CAV [17][18][19][20][21][22], perhaps due to stringent immunosuppression regimens [5].…”

“…The protocol for pre-and post-transplant immunosuppressive regimens used by our center when transplanting VAD patients has been recently described [5], including regimens for sensitized patients. No special immunosuppressive treatment protocol is followed for patients with an infection at the time of transplant.…”

Allosensitization in bridge to transplant Novacor left ventricular assist device patients: analysis of long-term outcomes with regard to acute rejection and chronic allograft vasculopathy☆

“…Left ventricular assist devices, due to their specific physical properties, their blood-contacting surface and the frequent need for blood product support [3,4], have been shown to be responsible for allosensitization through upregulation of the immune system and an increased antibody production [5,6], though its true impact on transplantation outcome is still a matter of debate [7][8][9][10][11][12][13]. Allosensitization can translate into an increase in cellular and/or humoral immunity [5,6], putting the transplant recipient at risk for both acute and chronic rejection.…”

Observational Study With Everolimus (Certican) in Combination With Low-dose Cyclosporine in De Novo Heart Transplant Recipients

“…Furthermore, bridging with a VAD has shown little impact on the short-term outcomes of heart transplantation with similar overall survival rates and no increase in acute rejection or cardiac allograft vasculopathy. 20,21 This observational study has shown that standard dosing of everolimus in de novo heart transplant recipients initiated prior to transplantation achieves the recommended C0 target range of 3 to 8 ng/ml 13,15,16 within 2 weeks after transplant (71.05%; 2 patients with everolimus levels Ͻ3 ng/ml) remaining stable throughout 12 months. Furthermore, the results indicate that maintaining everolimus C0 level within this therapeutic window allows for a pronounced reduction in CsA C0 levels compared with patients receiving MMF, without increasing the risk of acute rejection.…”