LVAD implant as a bridge to heart transplantation is associated with allosensitization as measured by single antigen bead assay

Nisha Shankar, Richard Daly, Jennifer Geske, Sudhir K. Kushwaha, Michael Timmons, Lyle Joyce, John Stulak, Manish Gandhi, Walter K Kremers, Soon Park, Naveen Luke Pereira

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Left ventricular assist devices (LVAD) as a bridge (BTT) to heart transplantation (HTX) may be limited by the formation of anti-human leukocyte antigen antibodies. Whether sensitization occurs with continuous axial flow LVAD implant as assessed by single antigen bead (SAB) assay is unknown. Methods: Cytotoxic panel-reactive antibody (PRA) and SAB assays were analyzed in HTX recipients undergoing LVAD implant as a BTT. Sensitization was defined as peak anti-human leukocyte antigen antibody values of more than 2000 mean fluorescence intensity because these values have been found to correlate with flow cytometric crossmatch results. Results: LVADs were implanted as BTT in 30 patients. There were 7% (2 of 30) of patients before LVAD implant and no patients after LVAD implant with PRA more than 10%. However, 20% (6 of 30) of patients before LVAD and 53% (16 of 30) after LVAD were sensitized as measured by SAB (P=0.024). At HTX, 47% (14 of 30) of patients remained sensitized. A positive virtual crossmatch was observed in 28% (4 of 14) of the sensitized patients at HTX. There was no difference between the sensitized and nonsensitized groups (P>0.4 for all) in usage of blood products (6411 vs. 6339 units) and time to HTX (28,663 vs. 25,748 days), and 1 year after HTX, there were no differences in rejection (total rejection score 0.30 vs. 0.37) and survival (93% vs. 88%). Conclusion: Allosensitization after LVAD is common despite cytotoxic PRA being negative. One year after HTX, this sensitization does not translate into increased acute cellular or antibody-mediated rejection or reduced survival.

Original languageEnglish (US)
Pages (from-to)324-330
Number of pages7
JournalTransplantation
Volume96
Issue number3
DOIs
StatePublished - Aug 15 2013

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Heart-Assist Devices
Heart Transplantation
Antigens
Antibodies
HLA Antigens
Survival
Fluorescence

Keywords

  • Heart transplant
  • HLA
  • Left ventricular assist device
  • Single antigen bead assay

ASJC Scopus subject areas

  • Transplantation

Cite this

LVAD implant as a bridge to heart transplantation is associated with allosensitization as measured by single antigen bead assay. / Shankar, Nisha; Daly, Richard; Geske, Jennifer; Kushwaha, Sudhir K.; Timmons, Michael; Joyce, Lyle; Stulak, John; Gandhi, Manish; Kremers, Walter K; Park, Soon; Pereira, Naveen Luke.

In: Transplantation, Vol. 96, No. 3, 15.08.2013, p. 324-330.

Research output: Contribution to journalArticle

Shankar, Nisha ; Daly, Richard ; Geske, Jennifer ; Kushwaha, Sudhir K. ; Timmons, Michael ; Joyce, Lyle ; Stulak, John ; Gandhi, Manish ; Kremers, Walter K ; Park, Soon ; Pereira, Naveen Luke. / LVAD implant as a bridge to heart transplantation is associated with allosensitization as measured by single antigen bead assay. In: Transplantation. 2013 ; Vol. 96, No. 3. pp. 324-330.
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title = "LVAD implant as a bridge to heart transplantation is associated with allosensitization as measured by single antigen bead assay",
abstract = "Background: Left ventricular assist devices (LVAD) as a bridge (BTT) to heart transplantation (HTX) may be limited by the formation of anti-human leukocyte antigen antibodies. Whether sensitization occurs with continuous axial flow LVAD implant as assessed by single antigen bead (SAB) assay is unknown. Methods: Cytotoxic panel-reactive antibody (PRA) and SAB assays were analyzed in HTX recipients undergoing LVAD implant as a BTT. Sensitization was defined as peak anti-human leukocyte antigen antibody values of more than 2000 mean fluorescence intensity because these values have been found to correlate with flow cytometric crossmatch results. Results: LVADs were implanted as BTT in 30 patients. There were 7{\%} (2 of 30) of patients before LVAD implant and no patients after LVAD implant with PRA more than 10{\%}. However, 20{\%} (6 of 30) of patients before LVAD and 53{\%} (16 of 30) after LVAD were sensitized as measured by SAB (P=0.024). At HTX, 47{\%} (14 of 30) of patients remained sensitized. A positive virtual crossmatch was observed in 28{\%} (4 of 14) of the sensitized patients at HTX. There was no difference between the sensitized and nonsensitized groups (P>0.4 for all) in usage of blood products (6411 vs. 6339 units) and time to HTX (28,663 vs. 25,748 days), and 1 year after HTX, there were no differences in rejection (total rejection score 0.30 vs. 0.37) and survival (93{\%} vs. 88{\%}). Conclusion: Allosensitization after LVAD is common despite cytotoxic PRA being negative. One year after HTX, this sensitization does not translate into increased acute cellular or antibody-mediated rejection or reduced survival.",
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T1 - LVAD implant as a bridge to heart transplantation is associated with allosensitization as measured by single antigen bead assay

AU - Shankar, Nisha

AU - Daly, Richard

AU - Geske, Jennifer

AU - Kushwaha, Sudhir K.

AU - Timmons, Michael

AU - Joyce, Lyle

AU - Stulak, John

AU - Gandhi, Manish

AU - Kremers, Walter K

AU - Park, Soon

AU - Pereira, Naveen Luke

PY - 2013/8/15

Y1 - 2013/8/15

N2 - Background: Left ventricular assist devices (LVAD) as a bridge (BTT) to heart transplantation (HTX) may be limited by the formation of anti-human leukocyte antigen antibodies. Whether sensitization occurs with continuous axial flow LVAD implant as assessed by single antigen bead (SAB) assay is unknown. Methods: Cytotoxic panel-reactive antibody (PRA) and SAB assays were analyzed in HTX recipients undergoing LVAD implant as a BTT. Sensitization was defined as peak anti-human leukocyte antigen antibody values of more than 2000 mean fluorescence intensity because these values have been found to correlate with flow cytometric crossmatch results. Results: LVADs were implanted as BTT in 30 patients. There were 7% (2 of 30) of patients before LVAD implant and no patients after LVAD implant with PRA more than 10%. However, 20% (6 of 30) of patients before LVAD and 53% (16 of 30) after LVAD were sensitized as measured by SAB (P=0.024). At HTX, 47% (14 of 30) of patients remained sensitized. A positive virtual crossmatch was observed in 28% (4 of 14) of the sensitized patients at HTX. There was no difference between the sensitized and nonsensitized groups (P>0.4 for all) in usage of blood products (6411 vs. 6339 units) and time to HTX (28,663 vs. 25,748 days), and 1 year after HTX, there were no differences in rejection (total rejection score 0.30 vs. 0.37) and survival (93% vs. 88%). Conclusion: Allosensitization after LVAD is common despite cytotoxic PRA being negative. One year after HTX, this sensitization does not translate into increased acute cellular or antibody-mediated rejection or reduced survival.

AB - Background: Left ventricular assist devices (LVAD) as a bridge (BTT) to heart transplantation (HTX) may be limited by the formation of anti-human leukocyte antigen antibodies. Whether sensitization occurs with continuous axial flow LVAD implant as assessed by single antigen bead (SAB) assay is unknown. Methods: Cytotoxic panel-reactive antibody (PRA) and SAB assays were analyzed in HTX recipients undergoing LVAD implant as a BTT. Sensitization was defined as peak anti-human leukocyte antigen antibody values of more than 2000 mean fluorescence intensity because these values have been found to correlate with flow cytometric crossmatch results. Results: LVADs were implanted as BTT in 30 patients. There were 7% (2 of 30) of patients before LVAD implant and no patients after LVAD implant with PRA more than 10%. However, 20% (6 of 30) of patients before LVAD and 53% (16 of 30) after LVAD were sensitized as measured by SAB (P=0.024). At HTX, 47% (14 of 30) of patients remained sensitized. A positive virtual crossmatch was observed in 28% (4 of 14) of the sensitized patients at HTX. There was no difference between the sensitized and nonsensitized groups (P>0.4 for all) in usage of blood products (6411 vs. 6339 units) and time to HTX (28,663 vs. 25,748 days), and 1 year after HTX, there were no differences in rejection (total rejection score 0.30 vs. 0.37) and survival (93% vs. 88%). Conclusion: Allosensitization after LVAD is common despite cytotoxic PRA being negative. One year after HTX, this sensitization does not translate into increased acute cellular or antibody-mediated rejection or reduced survival.

KW - Heart transplant

KW - HLA

KW - Left ventricular assist device

KW - Single antigen bead assay

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