De Novo Human Leukocyte Antigen Allosensitization in Heartmate 3 Versus Heartmate II Left Ventricular Assist Device Recipients.

Autor:	Jain R; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Habal MV; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Clerkin KJ; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Latif F; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Restaino SW; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Zorn E; Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, New York., Takeda K; Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Naka Y; Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York., Yuzefpolskaya M; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Farr MA; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Colombo PC; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Sayer GT; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Uriel N; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York., Topkara VK; From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2022 Feb 01; Vol. 68 (2), pp. 226-232.
DOI:	10.1097/MAT.0000000000001451
Abstrakt:	Left ventricular assist devices (LVADs) are associated with the development of antihuman leukocyte antigen (HLA) antibodies, which can create a challenge for future transplantation in these patients. The differential effects of Heartmate 3 (HM3) versus Heartmate II (HMII) on de novo HLA allosensitization remain unknown. Patients who underwent HMII or HM3 implantation and had no prior HLA antibodies by solid-phase assay (Luminex) testing were included in this study. Complement-dependent cytotoxicity (CDC) panel reactive antibody (PRA) levels and Luminex antibody profiles were followed until cardiac transplantation, device explantation, or death. Electronic medical records were reviewed to examine posttransplant outcomes. Thirty-eight HM3 and 34 HMII patients with complete data were followed for 1.5 ± 1.1 years on device support. HM3 and HMII groups had similar age at implant, female gender, ischemic heart failure etiology, bridge strategy at implant, as well as intraoperative and postoperative transfusion requirements. 39.5% of HM3 and 47.1% of HMII patients developed detectable HLA antibodies by Luminex testing (p = 0.516). Development of high-level (mean fluorescence intensity >10,000) antibodies was significantly lower in HM3 than HMII patients (5.3 vs. 20.6%, p = 0.049). CDC PRA testing showed fewer HM3 patients with a positive result (PRA > 0%) than HMII patients (39.4 vs. 70.0%, p = 0.015). Among transplanted patients, those who had developed de novo sensitization on LVAD support showed a trend toward incidence of moderate to severe grade rejection compared with unsensitized patients (23.8 vs. 4.8%, p = 0.078). HM3 is associated with lower risk of de novo HLA sensitization compared with HMII. (Copyright © ASAIO 2021.)
Databáze:	MEDLINE
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