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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

^a Transplantation Unit, Cardiovascular Department, U.C.L. Saint Luc Hospital, Brussels, Belgium
^b Department of Immuno-Hematology, U.C.L. Saint Luc Hospital, Brussels, Belgium

Received 5 September 2007; received in revised form 27 March 2008; accepted 31 March 2008.

^_* Corresponding author. Address: Cardio-Vascular and Thoracic Surgery Unit, U.C.L. Saint Luc Hospital, Université catholique de Louvain, Avenue Hippocrate 10, B-1200, Brussels, Belgium. Tel.: +32 2 7646107; fax: +32 2 7648960. (Email: Poncelet{at}chir.ucl.ac.be).

Background: The true relevance of allosensitization in patients benefiting from left ventricular assist device (LVAD) as bridge to transplant (BTT) is still debated. Available registry data referred to numerous devices precluding LVAD-specific analysis. Therefore, we studied all patients with Novacor LVAD prior to transplantation. Methods: From 1985 to 2006, 37 Novacor LVADs were implanted as BTT, with 30 patients surviving to transplantation (81%). Post-LVAD sensitization was determined for anti-HLA-class I and class II IgGs. Study endpoints were overall survival and/or graft loss, 3A cellular rejection and chronic allograft vasculopathy (CAV). The results from LVAD patients were compared to non-LVAD primary heart transplant recipients (n = 318). Results: After LVAD insertion, 5 out of 27 patients available for analysis developed anti-HLA antibodies (18.5%). The mean anti-HLA titer after Novacor LVAD implantation was 14% [SD 31]. Actuarial 5- and 10-year patient/graft survival for LVAD and non-LVAD transplant recipients were 73% and 55%, and 70% and 55%, respectively (p = NS). Overall prevalence of rejection 3A was 23.3 % (LVAD group) and 18.9% (non-LVAD group) (p = NS). At follow-up, the respective incidence of CAV was 8% (LVAD group) and 32.4% (non-LVAD group) (p < 0.01). However, mean follow-up was significantly different for LVAD and non-LVAD patients, 46 vs 90 months (p < 0.001). Conclusion: In this study, allosensitization occurred infrequently after Novacor LVAD implantation. Secondly, analysis of outcome variables shows that Novacor-LVAD BTT patients can anticipate similar survival to non-LVAD patients, thus minimizing the impact of allosensitization after LVAD implantation.

Key Words: Assist device • Transplantation • Rejection • Allograft vasculopathy