HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ranjit John Yoshifumi Naka Vivek Rao Eric A. Rose Craig R. Smith Mehmet C. Oz Niloo M. Edwards Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by John, R. Articles by Itescu, S. Search for Related Content PubMed PubMed Citation Articles by John, R. Articles by Itescu, S. Related Collections Mechanical Circulatory Assistance

J Thorac Cardiovasc Surg 2003;125:578-591
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Immunologic sensitization in recipients of left ventricular assist devices

From the Departments of Surgery^a Cardiology,^b Columbia University College of Physicians and Surgeons, New York, NY.

Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, San Diego, Calif, June 20-23, 2001.

Received for publication June 28, 2001. Revisions requested Aug 28, 2001; revisions received Jan 22, 2002. Accepted for publication April 12, 2002. Address for reprints: Ranjit John, MD, Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Milstein Hospital Building 7-435, New York, NY 10032 (E-mail: ranjitj{at}pol.net).

Objective: Left ventricular assist device implantation is associated with an increased risk of development of circulating anti-HLA class I and II antibodies (sensitization). We investigated the impact of sensitization on posttransplantation outcomes in 105 consecutive left ventricular assist device recipients.
Methods: Five hundred twenty-one consecutive adult cardiac allograft recipients between 1992 and 1999 were retrospectively studied. Of these, 105 were supported with a left ventricular assist device. Pretransplantation and posttransplantation antibody production, time to transplantation after listing, rejection, freedom from transplant coronary artery disease, and survival were evaluated by Kaplan-Meier analysis. Among sensitized left ventricular assist device recipients, 26 were treated with a pretransplantation immunomodulatory regimen consisting of intravenous immunoglobulin and cyclophosphamide.
Results: There were no significant differences between left ventricular assist device recipients and nonbridged recipients with respect to pretransplantation demographic characteristics and ABO and HLA matching. Among left ventricular assist device recipients, 66% (69/105) were sensitized before transplantation; in contrast, only 6% (24/399) of nonbridged recipients were sensitized (P < .001). Sensitized untreated left ventricular assist device recipients had both a prolongation of waiting time to transplantation and an increased risk of acute rejection. Pretransplantation immunomodulatory therapy reduced both the increased waiting time and the increased risk of acute rejection. However, sensitization or the use of immunomodulatory therapy in left ventricular assist device-bridged recipients did not influence posttransplantation survival relative to nonbridged recipients.
Conclusions: Left ventricular assist device recipients have survival outcomes similar to those of nonbridged recipients after cardiac transplantation, despite their significantly higher immunologic risk. The reduced rate of transplantation and the increased incidence of rejection observed in sensitized left ventricular assist device recipients are prevented by immunomodulatory therapy. Sensitization will remain an important issue with increased use of left ventricular assist devices, and improved understanding of this is essential to achieve better outcomes in the management of patients with end-stage heart failure.

This article has been cited by other articles:

				L. Kirsch, T. Timmermans, O. Van Caenegem, O. Gurne, P. Noirhomme, L.-M. Jacquet, D. Latinne, and A. J. Poncelet 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. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 268 - 274. [Abstract] [Full Text] [PDF]

				A. Garatti, G. Bruschi, T. Colombo, C. Russo, M. Lanfranconi, F. Milazzo, M. Frigerio, and E. Vitali Clinical outcome and bridge to transplant rate of left ventricular assist device recipient patients: comparison between continuous-flow and pulsatile-flow devices. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 275 - 280. [Abstract] [Full Text] [PDF]

				I. George, P. Colley, M. J. Russo, T. P. Martens, E. Burke, M. C. Oz, M. C. Deng, D. M. Mancini, and Y. Naka Association of device surface and biomaterials with immunologic sensitization after mechanical support. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1372 - 1379.e1. [Abstract] [Full Text] [PDF]

				R. R. Davies, M. J. Russo, K. N. Hong, M. L. O'Byrne, D. P. Cork, A. J. Moskowitz, A. C. Gelijns, S. Mital, R. S. Mosca, and J. M. Chen The use of mechanical circulatory support as a bridge to transplantation in pediatric patients: an analysis of the United Network for Organ Sharing database. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 421 - 427. [Abstract] [Full Text] [PDF]

				S. Aggarwal, F. Cheema, M. C. Oz, and Y. Naka Long-Term Mechanical Circulatory Support Card. Surg. Adult, January 1, 2008; 3(2008): 1609 - 1628. [Full Text]

				L. U. Nwakanma, J. A. Williams, E. S. Weiss, S. D. Russell, W. A. Baumgartner, and J. V. Conte Influence of Pretransplant Panel-Reactive Antibody on Outcomes in 8,160 Heart Transplant Recipients in Recent Era Ann. Thorac. Surg., November 1, 2007; 84(5): 1556 - 1563. [Abstract] [Full Text] [PDF]

				M. S. Sharma, S. A. Webber, V. O. Morell, S. K. Gandhi, P. D. Wearden, J. R. Buchanan, and R. L. Kormos Ventricular assist device support in children and adolescents as a bridge to heart transplantation. Ann. Thorac. Surg., September 1, 2006; 82(3): 926 - 932. [Abstract] [Full Text] [PDF]

				N. C. Dang, V. K. Topkara, B. T. Kim, B. J. Lee, R. Remoli, and Y. Naka Nutritional status in patients on left ventricular assist device support J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): e3 - e4. [Full Text] [PDF]

				J.-M. Grinda, M.-O. Bricourt, C. Amrein, S. Salvi, R. Guillemain, A. Francois, P. Guibourt, A. Deloche, and J.-N. Fabiani Human Leukocyte Antigen Sensitization in Ventricular Assist Device Recipients: A Lesser Risk With the DeBakey Axial Pump Ann. Thorac. Surg., September 1, 2005; 80(3): 945 - 948. [Abstract] [Full Text] [PDF]

				J. S. Gammie, L. B. Edwards, B. P. Griffith, R. N. Pierson III, and L. Tsao Optimal timing of cardiac transplantation after ventricular assist device implantation J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1789 - 1799. [Abstract] [Full Text] [PDF]

				J. A. Morgan, R. John, V. Rao, A. D. Weinberg, B. J. Lee, P. A. Mazzeo, M. R. Flannery, J. M. Chen, M. C. Oz, and Y. Naka Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1309 - 1316. [Abstract] [Full Text] [PDF]