Faculty Collaboration Database

Effect of Pretransplant Continuous-Flow Left Ventricular Assist Devices on Cellular and Antibody-Mediated Rejection and Subsequent Allograft Outcomes. Am J Cardiol 2017 Feb 01;119(3):452-456

Date

12/13/2016

Pubmed ID

27939231

DOI

10.1016/j.amjcard.2016.10.020

Scopus ID

2-s2.0-85008173459 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

The aim of this study was to evaluate the impact of continuous-flow left ventricular assist devices (CF-LVAD) on subsequent rejection after heart transplantation (HT) by using cellular rejection score and antibody-mediated rejection score (AMRS) and correlating with subsequent allograft outcomes. We retrospectively analyzed 108 consecutive patients who underwent HT without (n = 67) or with (n = 41) previous CF-LVAD in 2008 to 2014. The 24 months cumulative effect of rejection was calculated by using cellular rejection scores and AMRS, based on the total number of rejections divided by valid biopsy samples. Vasculopathy was assessed both by routine coronary angiogram and intravascular ultrasound. Patients who underwent pretransplant CF-LVAD demonstrated a significant increase in the number of cellular rejection episodes as compared with the nonbridged patients, for 1 and 2 years of follow-up (p = 0.026 and p = 0.016), respectively. There were no differences in AMRS (p >0.05) and allograft outcomes, such as vasculopathy and overall survival (p >0.05) over the period of follow-up. Implantation of a CF-LVAD before HT impacts cellular rejection during the post-transplant period. Despite these findings, CF-LVAD does not translate to differences in allograft outcomes after transplant, such as vasculopathy and overall survival over the period of the study. In conclusion, whether this affects longer term outcomes than studied remains to be determined.

Author List

Nestorovic EM, Grupper A, Joyce LD, Milic NM, Stulak JM, Edwards BS, Pereira NL, Daly RC, Kushwaha SS

MESH terms used to index this publication - Major topics in bold

Adult
Antibodies
Cardiomyopathies
Cardiomyopathy, Dilated
Case-Control Studies
Female
Graft Rejection
Heart Failure
Heart Transplantation
Heart-Assist Devices
Humans
Immunity, Cellular
Immunity, Humoral
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia
Proportional Hazards Models
Retrospective Studies
Transplantation, Homologous