Korean J Transplant.  2021 Oct;35(Supple 1):S24. 10.4285/ATW2021.OR-1020.

Post-transplantation outcomes of sensitized mechanical circulatory support patients

• Youn JC
• Kim JJ
• Baek SH
• Kobashigawa J

• KMID: 2521235
• DOI: http://doi.org/10.4285/ATW2021.OR-1020

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 HTx recipients between 2010 and 2018 in Cedars-Sinai Medical Center, 86 sensitized MCS patients (9.7%, 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.