Effect of Pretransplant Continuous-Flow Left Ventricular Assist Devices on Cellular and Antibody-Mediated Rejection and Subsequent Allograft Outcomes

Cardiac allograft rejection in the current era of continuous flow left ventricular assist devices

“…Nestorovic and colleagues 15 demonstrated an increased incidence of ACR for CF-LVAD patients, as measured by a composite cellular rejection score on 1R and 2R/3R ACR, but did not associate this increased burden with mortality or cardiac allograft vasculopathy. The reported incidence of 2R/3R ACR was consistently lower for CF-LVAD patients relative to Primary Tx during the first 2 years of follow-up, a trend we also observed in our data.…”

“…Several studies have associated CF-LVAD use with increased allosensitization but have drawn mixed conclusions regarding the influence of this allosensitization on rejection after transplant. 15,16,24 Recent work by Ko and colleagues 16 examining CF-LVAD as a predictor of ACR and mortality found no difference in the incidence of ACR on the basis of CF-LVAD support alone but did associate new allosensitization with PRA >10% after CF-LVAD implantation with ACR. Fraser and colleagues 25 found that with a PRA cutoff of 25% defining high sensitization, sensitized CF-LVAD patients did not experience higher rates of ACR.…”

“…14 However, the clinical influence of this sensitization on posttransplant rejection is debated. Some studies have demonstrated CF-LVAD support as an independent predictor of ACR, 15 whereas others have associated new sensitization after CF-LVAD implantation or increased duration of support with rejection. 16,17 Furthermore, studies in national cohorts have not demonstrated an association between increased allosensitization among patients with an LVAD and incidence of treated rejection or posttransplant mortality.…”

Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists

“…Magruder et al 56 HeartMate II and HeartWare had comparable early and 1-year mortality in BTT patients. Allosensitization in patients with LVAD support before CTX Nestorovic et al 57 Increased number of ACR episodes in LVAD BTT patients. No difference in survival or CAV.…”

“…Therefore, the effects of LVAD therapy on the occurrence of rejection and other post-heart transplantation outcomes, including CAV, are areas of active research. In this field, Nestorovic et al 57 evaluated the impact of LVAD implantation on the occurrence of both acute cellular rejection (ACR) and AMR. The authors retrospectively calculated both ACR and AMR scores based on the total number of rejections divided by valid biopsy samples during a 2-year period.…”