Clinical outcomes in sensitized heart transplant patients bridged with ventricular assist devices

Background: Left ventricular assist devices (LVADs) as a bridge to transplant (BTT) have been known to cause allosensitization, as measured by panel-reactive antibody (PRA) levels. The goal of this study was to measure the impact of this allosensitization on outcomes. Methods: Panel-reactive antibodies were analyzed in BTT patients, with sensitization defined as peak PRAs ≥ 10%. Baseline characteristics and outcomes in the two patient groups were evaluated using descriptive statistics, Kaplan-Meier, and regression analysis. Results: Thirty-eight patients were included in the study (17 sensitized vs. 21 non-sensitized). There were more women in the sensitized group (47% vs. 10%, p = 0.023). There was no difference in mean times to high-grade acute cellular rejection (ACR; 18.3 months in sensitized vs. 36.9 months in non-sensitized). Five patients in the sensitized groups developed antibody-mediated rejection (AMR) vs. 0 in the non-sensitized, and all five patients died (Kaplan-Meier log-rank p = 0.024). There was also a significant difference in the incidence of infection at the one- to six-month stage (52.9% vs. 19.0%, p = 0.03). Conclusion: Sensitization appears to have a negative effect on mortality. This mortality appears to be concentrated in patients with AMR, and we postulate that the development of AMR in a sensitized patient may be a predictor of mortality.