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J Thorac Cardiovasc Surg 2004;127:1800-1807
© 2004 The American Association for Thoracic Surgery

Cardiothoracic transplantation

HLA sensitization in ventricular assist device recipients: Does type of device make a difference?

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^b Allogen Labora-tory, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^c Department of Biostatistics and Epidemiology,, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^d Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Presented at the Twenty-first Annual Meeting of the International Society for Heart and Lung Transplantation, Vancouver, Canada, April 25-29, 2001, and the Transplant 2001 Meeting (joint meeting of the American Society of Transplantation/American Society of Transplant Surgeons), Chicago, Ill, May 12-16, 2001.

Received for publication July 23, 2003; revisions received December 2, 2003; revisions received January 21, 2004; accepted for publication January 27, 2004.

^* Address for reprints: Patrick M. McCarthy, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195, USA
mccartp{at}ccf.org

BACKGROUND: We sought to (1) characterize the temporal pattern of T-cell panel reactive antibody during ventricular assist device support, (2) identify predictors of higher T-cell panel reactive antibody during ventricular assist device support, and (3) determine whether device type remained a predictor after accounting for nonrandom device selection.

METHODS: Between December 1991 and August 2000, 239 patients received implantable ventricular assist devices, of whom 231 had T-cell panel reactive antibody measured. Panel reactive antibody was measured before implantation of the assist device, approximately 2 weeks after device implantation, irregularly thereafter depending on clinical events and length of support, and at transplantation. Longitudinal mixed modeling was used to characterize the temporal pattern of sensitization and its predictors during ventricular assist device support. To account for nonrandom factors in device selection when comparing HeartMate (Thermo Cardiosystems, Inc, Woburn, Mass) and Novacor (Baxter Healthcare Corp, Novacor Div, Oakland, Calif) devices, we propensity-matched patients according to baseline characteristics.

RESULTS: T-cell panel reactive antibody increased rapidly after implantation of the ventricular assist device and then immediately began to decrease. Predictors of higher T-cell panel reactive antibody during support with the assist device were a shorter interval from device implantation to T-cell panel reactive antibody measurement (P < .0001), female sex (P = .0004), younger age (P = .01), higher T-cell panel reactive antibody before device implantation (P = .03), more perioperative red blood cell transfusions (P = .006), and an earlier date of device implantation (P = .001). In matched patients, device type was not a predictor of higher T-cell panel reactive antibody during ventricular assist device support (P = .8).

CONCLUSIONS: HLA sensitization during ventricular assist device support is not constant but increases rapidly at implantation and then decreases. This temporal pattern of sensitization is influenced by patient factors and not by the type of device.

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