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Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2007;133:1612-1619
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Prevalence and risks of allosensitization in HeartMate left ventricular assist device recipients: The impact of leukofiltered cellular blood product transfusions

Stavros G. Drakos, MDa, James C. Stringham, MDa,c,d,*, James W. Long, MD, PhDa,b, Edward M. Gilbert, MDa,d, Thomas C. Fuller, PhDa,d, Beverly K. Campbell, RNa,b, Benjamin D. Horne, PhD, MPHa,b, Mary E. Hagan, FNPa,c, Karl E. Nelson, RNa,b, Judy M. Lindblom, MTb, Patty A. Meldrum, RNd, Joanne F. Carlson, MS, NP*,a,d, Stephanie A. Moore, MDa,b, Abdallah G. Kfoury, MDa,b, Dale G. Renlund, MDa,b,d

a Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, Salt Lake City, Utah
b LDS Hospital, Salt Lake City, Utah
c Salt Lake Veteran’s Affairs Medical Center, Salt Lake City, Utah
d University of Utah School of Medicine, Salt Lake City, Utah.

Received for publication June 7, 2006; revisions received October 4, 2006; accepted for publication November 9, 2006.

* Address for reprints: James C. Stringham, MD, Division of Cardiothoracic Surgery, University of Utah School of Medicine, 30 N 1900 E, Suite 3C127, Salt Lake City, UT 84132. (Email: jamesstringham{at}msn.com).

Objective: Allosensitization of left ventricular assist device recipients has been associated with perioperative transfusion of cellular blood products. The relative sensitizing contribution of leukofiltered cellular blood products, however, remains unclear. We investigated the pattern of sensitization in left ventricular assist device recipients in relation to cellular blood product transfusions received.

Methods: Seventy-one consecutive nonsensitized recipients of the HeartMate left ventricular assist device (Thoratec Corporation, Pleasanton, Calif) as a bridge to transplantation were reviewed. Panel-reactive HLA antibody levels at consecutive times after device implantation were correlated with perioperative cellular blood product transfusions.

Results: Fifty-four patients received leukofiltered cellular blood products (transfused), whereas 17 patients received only fresh-frozen plasma (nontransfused). Among nontransfused patients, 58.8% (10/17) became sensitized during mechanical support, versus 35.2% of transfused patients (19/54, P = .15). There was a trend toward more sensitization during the 12 weeks after device placement in nontransfused patients. Kaplan–Meier analysis revealed significantly more sensitization in nontransfused patients than in transfused patients, despite equal rates of transplantation (P = .05). A dose-response analysis revealed significant trends toward less sensitization and lower peak panel-reactive antibody level with more cellular blood product transfusions (P = .04). Multivariate Cox regression revealed only increasing transfusions to be associated with a reduced risk of sensitization (hazard ratio 0.18, P = .01).

Conclusions: Sensitization becomes more prevalent with increasing length of support. Avoidance of perioperative leukocyte-filtered cellular blood product transfusions does not decrease the incidence or degree of HLA sensitization. Conversely, cellular blood product transfusions may be associated with lessened alloimmunization and may mitigate the sensitization seen in recipients of the HeartMate left ventricular assist device as a bridge to transplantation.

Abbreviations and Acronyms CI = confidence interval; FFP = fresh-frozen plasma; HR = hazard ratio; LVAD = left ventricular assist device; PRA = panel-reactive antibody; pRBCs = packed red blood cells; Q1 = first quartile; Q2 = second quartile; Q3 = third quartile; Q4 = fourth quartile




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