Original Clinical Science
Three year post heart transplant outcomes of desensitized durable mechanical circulatory support patients

https://doi.org/10.1016/j.healun.2023.05.001Get rights and content

Background

The risks and benefits of desensitization therapy (DST) in highly sensitized mechanical circulatory support (MCS) patients are not well known. We investigated 3 year post-transplant outcomes of desensitized durable MCS patients.

Methods

Among 689 consecutively enrolled heart transplantation recipients between 2010 and 2016, we categorized them into Group A (desensitized MCS patients, n = 21), Group B (desensitized non-MCS patients, n = 28) and Group C (all nondesensitized patients, n = 640). Post-transplant outcomes included the incidence of primary graft dysfunction, 3-year survival, freedom from cardiac allograft vasculopathy, nonfatal major adverse cardiac events, any treated rejection, acute cellular rejection, antibody mediated rejection (AMR) and infectious complications.

Results

The types of DST in Groups A and B were similar and included combinations of rituximab/intravenous immunoglobulin and plasmapheresis/bortezomib. Group A, compared with Group B, showed significantly higher pre-DST panel reactive antibody (PRA) (92.2 ± 9.8 vs. 83.3 ± 15.6, P = 0.007) and higher PRA reduction after DST (−22.2 ± 26.9 vs. −6.3 ± 7.5, P = 0.015). Groups A and C showed comparable primary graft dysfunction, 3-year survival, freedom from cardiac allograft vasculopathy, nonfatal major adverse cardiac events, any treated rejection, acute cellular rejection, and AMR. Although statistically not significant, Group A showed numerically higher 3-year freedom from AMR than Group B. Infectious complications were similar in both Groups A and B.

Conclusions

DST for MCS patients showed significant PRA reduction, resulting in an expansion of the donor pool. The post-transplant outcome of desensitized MCS patients showed comparable clinical outcomes to non-desensitized control patients in the same study period, revealing the safety and efficacy of DST.

Section snippets

Study population

This study is a single-center prospective, observational analysis to assess the post-transplant outcome of desensitized MCS 201 patients. Among 689 consecutively enrolled patients who underwent HTx between 2010 and 6, 185 (26.8%) patients were bridged with MCS and 49 (7.1%) patients underwent DST. We categorized them into Group A (desensitized MCS patients, n = 21), Group B (desensitized non-MCS patients, n = 28), and Group C (all nondesensitized patients, n = 640). The desensitization

Baseline characteristics of study population

Among 689 consecutively enrolled patients who underwent HTx between 2010 and 2016, 185 patients were bridged with MCS. Type of MCS were left ventricular assisted device (LVAD) (n = 109), total artificial heart (n = 42), biventricular assisted device (n = 31), right ventricular assisted device (n = 2), and para-corporeal ventricular assisted device (n = 1). In this cohort, 49 (7.1%) patients were desensitized (desensitized MCS patients: 21/185 = 11.4%, desensitized non-MCS patients:

Discussion

With the improvement of MCS technology and management strategy, implantation of MCS in advanced heart failure patients increased. According to a recent world-wide registry report, 44.4% of the patients were bridged with MCS before HTx over the past decade.28 Previous studies reported a higher incidence of sensitization in patients supported with MCS.29, 30 Sensitization remains to be an important issue that limits a transplant candidate’s access to an organ, prolongs wait time and increases the

Conclusions

In conclusion, desensitized MCS patients, compared to desensitized non-MCS patients, showed higher PRA reduction after DST, resulting in an expansion of the donor pool. Desensitized MCS patients showed comparable clinical outcomes to nondesensitized control patients in consecutively enrolled contemporary HTx cohort revealing the safety and efficacy of DST. Based on our results, we recommend DST for highly sensitized MCS patients to increase the chances of HTx as MCS patients seem to better

Disclosure statement

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT (NRF-2021R1F1A1063430), by the Catholic Medical Center Research Foundation (2023) and by the grant from the Korean Society for Transplantation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

D.H.C. received research grants from Amgen, Biocardia, and Mesoblast and has moderate stock interest in

Acknowledgments

The authors express sincere gratitude to Christine Sumbi and other California Heart Center (an affiliate of Cedars-Sinai Smidt Heart Institute) research team members who enabled this long-term comprehensive study.

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    Contributed equally to this paper as first authors.

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