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Original article
DOI: 10.1016/j.rec.2021.01.017
Available online 14 April 2021
Sensitization during short-term mechanical circulatory support. Determinants, therapeutic management, and outcomes after heart transplant
Sensibilización durante la asistencia circulatoria de corta duración. Determinantes, tratamiento y pronóstico después del trasplante cardiaco
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Indira Cabrera-Rubio
Corresponding author
indira.cabrera@scsalud.es

Corresponding author: Floranes 29, 4.° derecha, 39010 Santander, Cantabria, Spain.
, Ángela Canteli Álvarez, Cristina Castrillo Bustamante, Virginia Burgos Palacios, Marta Ruiz Lera, Manuel Cobo Belaustegui, Miguel Fernando Llano Cardenal, Francisco González-Vílchez
Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Tables (6)
Table 1. Patients’ baseline characteristics
Table 2. Determinants of sensitization during short-term circulatory support as a bridge to transplant
Table 3. Characteristics, treatment strategies, and outcomes in patients who became sensitized during short-term bridge-to-transplant circulatory support
Table 4. Determinants of posttransplant mortality in patients on short-term bridge-to-transplant circulatory support (Cox regression)
Table 5. Characteristics of acute rejection and diagnostic-treatment protocol according to sensitization status
Table 6. Determinants of acute rejection in patients on short-term bridge-to-transplant circulatory support before transplantation (Cox regression)
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Abstract
Introduction and objectives

The development of human-leukocyte antigen antibodies is a well-known adverse effect of the use of long-term ventricular assist devices (VADs). The aim of this study was to determine the incidence of sensitization during short-term mechanical circulatory support with VAD (CentriMag), its determinants, and its impact on posttransplant outcomes.

Methods

We performed a retrospective review of patients who were bridged to transplant with short-term VAD from 2009 to 2019. Sensitization was defined as a calculated panel-reactive antibody> 10%. The endpoints included overall survival and rejection-free survival.

Results

A total of 89 patients (median age 56.0 [interquartile range, 50.0-59.9] years, 16.8% female) received a short-term VAD as a bridge to transplant. The median duration of support was 23.6 [interquartile range, 16.6-35.0] days. Eleven patients (12.4%) became sensitized during support. The only factor significantly associated with sensitization was female sex (OR, 8.67; 95%CI, 1.93–38.8; P=.005). Of the 89 patients, 21 patients died during support; 68 patients underwent heart transplant. After a mean follow-up of 49.6 ±31.2 months, 8 patients (11.8%) died and 20 (29.4%) had at least 1 rejection episode. On multivariate analysis, sensitization was an independent predictor of acute rejection (HR, 3.64; 95%CI, 1.42-9.33; P=.007), with a nonstatistically significant trend to higher mortality (HR, 4.07; 95%CI, 0.96-17.3; P=.057).

Conclusions

Sensitization with short-term VADs can occur and is significantly associated with female sex and with rejection. Sensitization also showed a nonstatistically significant trend to higher mortality.

Keywords:
Sensitization
Panel-reactive antibody
Ventricular assist device
Acute rejection
Abbreviations:
AR
cPRA
HLA
VAD
Resumen
Introducción y objetivos

El desarrollo de anticuerpos contra antígenos leucocitarios humanos es una complicación conocida de la asistencia ventricular de larga duración. El propósito del presente estudio es evaluar su incidencia durante el empleo de dispositivos de asistencia ventricular de corta duración (DAVC) (CentriMag), sus determinantes y su repercusión en los resultados del trasplante cardiaco.

Métodos

Estudio retrospectivo con pacientes tratados con DAVC como puente al trasplante entre 2009 y 2019. Se consideró sensibilización un panel reactivo de anticuerpos calculado> 10%. Las variables de respuesta fueron supervivencia y supervivencia libre de rechazo agudo (RA).

Resultados

Se trató con DAVC a 89 pacientes, con una mediana de edad de 56,0 [intervalo intercuartílico, 50,0-59,9] años y el 16,8% de mujeres, durante una mediana de 23,6 [16,6-35,0] días. El 12,4% se sensibilizó durante la asistencia. El único determinante independiente de la sensibilización fue el sexo femenino (OR=8,67; IC95%, 1,93-38,8; p=0,005). De los 89 pacientes, 21 fallecieron durante la asistencia y 68 se sometieron a trasplante. De los pacientes trasplantados, 8 (11,8%) fallecieron y 20 (29,4%) tuvieron algún episodio de RA tras un seguimiento promedio de 49,6 ±31,2 meses tras el trasplante. Tras ajuste multivariable, la sensibilización aumentó el riesgo de RA (HR=3,64; IC95%, 1,42-9,33; p=0,007), con una tendencia no significativa a mayor mortalidad (HR=4,07; IC95%, 0,96-17,3; p=0,057).

Conclusiones

La sensibilización relacionada con los DAVC es posible, predomina en el sexo femenino y se asocia de manera significativa con el RA, con una tendencia no significativa a mayor mortalidad.

Palabras clave:
Sensibilización
Panel reactivo de anticuerpos
Dispositivo de asistencia ventricular
Rechazo agudo

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