Factors associated with anti-human leukocyte antigen antibodies in patients supported with continuous-flow devices and effect on probability of transplant and post-transplant outcomes

被引：37

作者：

Alba, Ana C. ^{[1
]}

Tinckam, Kathryn ^{[1
]}

Foroutan, Farid ^{[1
]}

Nelson, Laerke M. ^{[2
]}

Gustafsson, Finn ^{[2
]}

Sander, Kam ^{[2
]}

Bruunsgaard, Hellen ^{[3
]}

Chih, Sharon ^{[4
]}

Hayes, Helen ^{[4
]}

Rao, Vivek ^{[1
]}

Delgado, Diego ^{[1
]}

Ross, Heather J. ^{[1
]}

机构：

[1] Toronto Gen Hosp, Univ Hlth Network, Heart Failure & Transplantat, Toronto, ON, Canada

[2] Univ Copenhagen, Rigshosp, Ctr Heart, DK-2100 Copenhagen, Denmark

[3] Univ Copenhagen, Rigshosp, Dept Clin Immunol, DK-2100 Copenhagen, Denmark

[4] Royal Perth Hosp, Adv Heart Failure & Cardiac Transplant Serv, Perth, WA 6001, Australia

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2015年 / 34卷 / 05期

关键词：

ventricular assist device therapy; panel reactive antibodies; advanced heart failure; human leukocyte antigen; transplant outcomes; VENTRICULAR ASSIST DEVICE; MECHANICAL CIRCULATORY SUPPORT; PANEL-REACTIVE ANTIBODY; STAGE HEART-FAILURE; CARDIAC TRANSPLANTATION; ALLOGRAFT-REJECTION; WAITING-TIMES; RISK-FACTOR; RECIPIENTS; SURVIVAL;

D O I：

10.1016/j.healun.2014.11.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: One major disadvantage of ventricular assist device (VAD) therapy is the development of human-leukocyte antigen (HLA) antibodies. We aimed to identify factors associated with HLA antibodies during continuous flow (CF)-VAD support and assess the effect on transplant probability and outcomes. METHODS: We included 143 consecutive heart failure patients who received a CF-VAD as a bridge-to-transplant at 3 institutions. Factors associated with post-VAD peak panel reactive antibodies (PRA) among several measurements were identified using multivariable linear regression. A parametric survival model was used to assess transplant waiting time and probability, risk of rejection, and a composite outcome of rejection, graft failure, and death. RESULTS: Thirty-six patients (25%) were female; mean age was 47 +/- 13 years. Eighty-one patients (57%) had a pre-VAD PRA of 0%, and 16 were highly sensitized (PRA > 80%). Age, female sex, and pre-VAD PRA were independently associated with post-VAD PRA. A 10-year increase in age was associated with a 5% decrease in post-VAD PRA (p = 0.03). Post-VAD PRA was 19% higher in women vs men (p < 0.01). A 10%-increase in pre-VAD PRA was associated with a 4.7% higher post-VAD PRA (p < 0.01). During a mean follow-up of 12 +/- 11 months, 90 patients underwent cardiac transplantation. A 20% increase in post-VAD PRA was associated with 13% lower probability of transplant (hazard ratio, 0.87; 95% confidence interval, 0.76-0.99). A high PRA was not associated with adverse post-transplant outcomes. CONCLUSIONS: Younger age, female sex, and pre-VAD PRA were independent predictors of elevated PRA post-VAD. Higher PRA was significantly associated with lower transplant probability but not increased rejection, graft failure, or death after transplant. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

引用

页码：685 / 692

页数：8

共 42 条

[1] The effect of ventricular assist devices on long-term post-transplant outcomes: a systematic review of observational studies [J].

Alba, Ana C. ;

McDonald, Michael ;

Rao, Vivek ;

Ross, Heather J. ;

Delgado, Diego H. .

EUROPEAN JOURNAL OF HEART FAILURE, 2011, 13 (07) :785-795

[2]

Amaoutakis GJ, 2011, J THORAC CARDIOVASC, V142, P1236

[3] Pregnancy can induce priming of cytotoxic T lymphocytes specific for paternal HLA antigens that is associated with antibody formation [J].

Bouma, GJ ;

vanCaubergh, P ;

vanBree, SPMJ ;

CastelliVisser, RMC ;

Witvliet, MD ;

vanderMeerPrins, EMW ;

vanRood, JJ ;

Class, FHJ .

TRANSPLANTATION, 1996, 62 (05) :672-678

[4]

Chih S, 2012, J HEART LUNG TRANSPL, V31, P780, DOI 10.1016/j.healun.2012.02.017

[5]

Cotts W G, 2001, Heart Fail Rev, V6, P227

[6] Prior Human Leukocyte Antigen-Allosensitization and Left Ventricular Assist Device Type Affect Degree of Post-implantation Human Leukocyte Antigen-Allosensitization [J].

Drakos, Stavros G. ;

Kfoury, Abdallah G. ;

Kotter, John R. ;

Reid, Bruce B. ;

Clayson, Stephen E. ;

Selzman, Craig H. ;

Stehlik, Josef ;

Fisher, Patrick W. ;

Merida, Mario, III ;

Eckels, David D. ;

Brunisholz, Kim ;

Horne, Benjamin D. ;

Stoker, Sandi ;

Li, Dean Y. ;

Renlund, Dale G. .

JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2009, 28 (08) :838-842

[7] Blood transfusions decrease the incidence of acute rejection in cardiac allograft recipients [J].

Fernández, FG ;

Jaramillo, A ;

Ewald, G ;

Rogers, J ;

Pasque, MK ;

Mohanakumar, T ;

Moazami, N .

JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2005, 24 (07) :S255-S261

[8] Ventricular assist devices and aggressive immunosuppression: Looking beyond overall survival [J].

Gonzalez-Stawinski, Gonzalo V. ;

Cook, Daniel J. ;

Chang, Albert S. Y. ;

Banbury, Michael K. ;

Navia, Jose L. ;

Hoercher, Katherine ;

Lober, Cheryl ;

Atik, Fernando A. ;

Taylor, David O. ;

Yamani, Mohamed H. ;

Young, James B. ;

Starling, Randall C. ;

Smedira, Nicholas G. .

JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2006, 25 (06) :613-618

[9] Consensus statement:: Palliative and supportive care in advanced heart failure [J].

Goodlin, SJ ;

Hauptman, PJ ;

Arnold, R ;

Grady, K ;

Hershberger, RE ;

Kutner, J ;

Masoudi, F ;

Spertus, J ;

Dracup, K ;

Cleary, JF ;

Medak, R ;

Crispell, K ;

Piña, I ;

Stuart, B ;

Whitney, C ;

Rector, T ;

Teno, J ;

Renlund, DG .

JOURNAL OF CARDIAC FAILURE, 2004, 10 (03) :200-209

[10] Ventricular assist devices as a bridge to cardiac transplantation: The Ottawa experience [J].

Haddad, M ;

Hendry, PJ ;

Masters, RG ;

Mesana, T ;

Haddad, H ;

Davies, RA ;

Mussivand, TV ;

Struthers, C ;

Keon, WJ .

ARTIFICIAL ORGANS, 2004, 28 (02) :136-141

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