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Post-transplantation outcomes of sensitized patients receiving durable mechanical circulatory support

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Author(s)
Jong-Chan YounXiaohai ZhangKeith Nishihara BSIn-Cheol KimSang Hong BaekOsamu SeguchiEvan P. KransdorfDavid H. ChangMichelle M. KittlesonJignesh K. PatelRobert M. ColeJaime D. MoriguchiDanny RamzyFardad EsmailianJon A. Kobashigawa
Alternative Author(s)
Kim, In Cheol
Department
Dept. of Internal Medicine (내과학)
Journal Title
J Heart Lung Transplant
Issued Date
2021
Volume
41
Number
3
Keyword
heart transplantationsensitizationmechanical circulatory supportprognosisantibody-mediated rejection
Abstract
Background:
Sensitization, defined as the presence of circulating antibodies, presents challenges, particularly in patients undergoing heart transplantation (HTx) bridged with durable mechanical circulatory support (MCS). We aimed to investigate the post-transplantation outcomes of sensitized MCS patients.

Methods:
Among 889 consecutively enrolled heart transplant (HTx) recipients between 2010 and 2018, 86 (9.7%) sensitized MCS patients (Group A) were compared with sensitized non–MCS patients (Group B, n = 189), non–sensitized MCS patients (Group C, n = 162), and non–sensitized non–MCS patients (Group D, n = 452) regarding post-HTx outcomes, including the incidence of primary graft dysfunction (PGD), 1-year survival, and 1-year freedom from antibody-mediated rejection (AMR).

Results:
Sensitized MCS patients (Group A) showed comparable rates of PGD, 1-year survival, and 1-year freedom from AMR with Groups C and D. However, Group A showed significantly higher rates of 1-year freedom from AMR (95.3% vs 85.7%, p = 0.02) and an earlier decline in panel-reactive antibody (PRA) levels ( p < 0.01) than sensitized non–MCS patients (Group B). Desensitization therapy effectively reduced the levels of PRA in both Groups A and B. When Group A was further divided according to the presence of preformed donor-specific antibodies (DSA), patients with preformed DSA showed significantly lower rates of 1-year freedom from AMR than those without (84.2% vs 98.5%, p = 0.01).

Conclusions:
Sensitized MCS patients showed significantly lower rates of AMR and an earlier decline in PRA levels following HTx than sensitized non–MCS patients. Removal of MCS at the time of transplantation might underlie these observations.
Affiliated Author(s)
김인철
Publisher
School of Medicine (의과대학)
Citation
Jong-Chan Youn et al. (2021). Post-transplantation outcomes of sensitized patients receiving durable mechanical circulatory support. J Heart Lung Transplant, 41(3), 365–372. doi: 10.1016/j.healun.2021.11.010
Type
Article
ISSN
1053-2498
Fulltext
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1053249821025870
DOI
10.1016/j.healun.2021.11.010
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44130
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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