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J Heart Lung Transplant. 2015 May;34(5):685-92. doi: 10.1016/j.healun.2014.11.024. Epub 2014 Dec 8.

Factors associated with anti-human leukocyte antigen antibodies in patients supported with continuous-flow devices and effect on probability of transplant and post-transplant outcomes.

Author information

1
Heart Failure and Transplantation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: carolina.alba@uhn.ca.
2
Heart Failure and Transplantation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
3
The Heart Centre.
4
Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
5
Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Western Australia, Australia.

Abstract

BACKGROUND:

One major disadvantage of ventricular assist device (VAD) therapy is the development of human-leukocyte antigen (HLA) antibodies. We aimed to identify factors associated with HLA antibodies during continuous flow (CF)-VAD support and assess the effect on transplant probability and outcomes.

METHODS:

We included 143 consecutive heart failure patients who received a CF-VAD as a bridge-to-transplant at 3 institutions. Factors associated with post-VAD peak panel reactive antibodies (PRA) among several measurements were identified using multivariable linear regression. A parametric survival model was used to assess transplant waiting time and probability, risk of rejection, and a composite outcome of rejection, graft failure, and death.

RESULTS:

Thirty-six patients (25%) were female; mean age was 47 ± 13 years. Eighty-one patients (57%) had a pre-VAD PRA of 0%, and 16 were highly sensitized (PRA > 80%). Age, female sex, and pre-VAD PRA were independently associated with post-VAD PRA. A 10-year increase in age was associated with a 5% decrease in post-VAD PRA (p = 0.03). Post-VAD PRA was 19% higher in women vs men (p < 0.01). A 10%-increase in pre-VAD PRA was associated with a 4.7% higher post-VAD PRA (p < 0.01). During a mean follow-up of 12 ± 11 months, 90 patients underwent cardiac transplantation. A 20% increase in post-VAD PRA was associated with 13% lower probability of transplant (hazard ratio, 0.87; 95% confidence interval, 0.76-0.99). A high PRA was not associated with adverse post-transplant outcomes.

CONCLUSIONS:

Younger age, female sex, and pre-VAD PRA were independent predictors of elevated PRA post-VAD. Higher PRA was significantly associated with lower transplant probability but not increased rejection, graft failure, or death after transplant.

KEYWORDS:

advanced heart failure; human leukocyte antigen; panel reactive antibodies; transplant outcomes; ventricular assist device therapy

PMID:
25638296
DOI:
10.1016/j.healun.2014.11.024
[Indexed for MEDLINE]

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