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Risk of dnDSA with Various MCS Devices as Bridge-to-Transplant

2019; Elsevier BV; Volume: 38; Issue: 4 Linguagem: Inglês

10.1016/j.healun.2019.01.211

1557-3117

Robert T. Cole, Maureen Flattery, Jonathan Minto, Aditya Parikh, Tiffany Dong, R. Roy, Linda Bogar, Andrew Smith, J. David Vega, Alanna A. Morris, S. Raja Laskar, K. Bhatt, D. Gupta, Anuradha Lala, Keyur B. Shah, P. Shah,

Cardiac Structural Anomalies and Repair

Purpose Previous reports have suggested an association between pre-transplant mechanical circulatory support (MCS) and an increased risk for post-transplant de novo donor specific antibodies (dnDSA). However, it is unclear if specific MCS devices pose a greater risk for dnDSA. The present study seeks to better understand the risk of dnDSA posed by a variety of MCS devices in a multicenter, collaborative study. Methods Multicenter, retrospective analysis of 319 heart transplant recipients from 4 U.S. centers between 2011 - 2017. The primary outcome was the development of post-transplant dnDSA. Results 145 of 319 (45%) patients were supported with durable MCS devices prior to transplant, including 47 Heartware (HVAD), 73 Heartmate II (HM2), and 25 total artificial hearts (TAH). MCS patients had a higher risk of dnDSA compared to those transplanted without mechanical support (37% vs. 23%, p = 0.006; Kaplan Meier log rank p < 0.001, Figure 1). No significant differences were seen between the devices in the risk of dnDSA (Heartware 36%, Heartmate II 38%, and TAH 32%, p = 0.848). However, when compared to patients transplanted without MCS support, patients bridged with HVAD and HM2 devices had higher risk for dnDSA, whereas no difference was seen between TAH to no MCS (Figure 2). Conclusion Pre-transplant MCS is associated with higher risk for dnDSA. Similar risk is seen regardless of device type; however, the risk associated with TAH was not significantly increased compared to no MCS. Previous reports have suggested an association between pre-transplant mechanical circulatory support (MCS) and an increased risk for post-transplant de novo donor specific antibodies (dnDSA). However, it is unclear if specific MCS devices pose a greater risk for dnDSA. The present study seeks to better understand the risk of dnDSA posed by a variety of MCS devices in a multicenter, collaborative study. Multicenter, retrospective analysis of 319 heart transplant recipients from 4 U.S. centers between 2011 - 2017. The primary outcome was the development of post-transplant dnDSA. 145 of 319 (45%) patients were supported with durable MCS devices prior to transplant, including 47 Heartware (HVAD), 73 Heartmate II (HM2), and 25 total artificial hearts (TAH). MCS patients had a higher risk of dnDSA compared to those transplanted without mechanical support (37% vs. 23%, p = 0.006; Kaplan Meier log rank p < 0.001, Figure 1). No significant differences were seen between the devices in the risk of dnDSA (Heartware 36%, Heartmate II 38%, and TAH 32%, p = 0.848). However, when compared to patients transplanted without MCS support, patients bridged with HVAD and HM2 devices had higher risk for dnDSA, whereas no difference was seen between TAH to no MCS (Figure 2). Pre-transplant MCS is associated with higher risk for dnDSA. Similar risk is seen regardless of device type; however, the risk associated with TAH was not significantly increased compared to no MCS.