Effect of Pretransplant Continuous-Flow Left Ventricular Assist Devices on Cellular and Antibody-Mediated Rejection and Subsequent Allograft Outcomes

• Published in: The American journal of cardiology 2017-02, Vol.119 (3), p.452-456
• Main Authors: Nestorovic, Emilija M., Grupper, Avishay, Joyce, Lyle D., Milic, Natasa M., Stulak, John M., Edwards, Brooks S., Pereira, Naveen L., Daly, Richard C., Kushwaha, Sudhir S.
• Format: Article
• Language: English
• Subjects: Adult; Antibodies - immunology; Antigens; Biopsy; Cardiomyopathies - etiology; Cardiomyopathies - therapy; Cardiomyopathy; Cardiomyopathy, Dilated - therapy; Case-Control Studies; Female; Graft Rejection - epidemiology; Graft Rejection - immunology; Heart; Heart Failure - therapy; Heart Transplantation; Heart-Assist Devices - utilization; Humans; Immunity, Cellular - immunology; Immunity, Humoral - immunology; Kaplan-Meier Estimate; Male; Medical imaging; Middle Aged; Multivariate Analysis; Myocardial Ischemia - complications; Patients; Proportional Hazards Models; Retrospective Studies; Studies; Transplantation, Homologous; Transplants & implants
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.10.020

The aim of this study was to evaluate the impact of continuous-flow left ventricular assist devices (CF-LVAD) on subsequent rejection after heart transplantation (HT) by using cellular rejection score and antibody-mediated rejection score (AMRS) and correlating with subsequent allograft outcomes. We retrospectively analyzed 108 consecutive patients who underwent HT without (n = 67) or with (n = 41) previous CF-LVAD in 2008 to 2014. The 24 months cumulative effect of rejection was calculated by using cellular rejection scores and AMRS, based on the total number of rejections divided by valid biopsy samples. Vasculopathy was assessed both by routine coronary angiogram and intravascular ultrasound. Patients who underwent pretransplant CF-LVAD demonstrated a significant increase in the number of cellular rejection episodes as compared with the nonbridged patients, for 1 and 2 years of follow-up (p = 0.026 and p = 0.016), respectively. There were no differences in AMRS (p >0.05) and allograft outcomes, such as vasculopathy and overall survival (p >0.05) over the period of follow-up. Implantation of a CF-LVAD before HT impacts cellular rejection during the post-transplant period. Despite these findings, CF-LVAD does not translate to differences in allograft outcomes after transplant, such as vasculopathy and overall survival over the period of the study. In conclusion, whether this affects longer term outcomes than studied remains to be determined.