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Transplantation of high panel-reactive antibody left ventricular assist device patients without crossmatch using on-bypass pheresis and alemtuzumab.

Publication ,  Journal Article
Lick, SD; Beckles, DL; Piovesana, G; Vaidya, S; Indrikovs, A; Barbagelata, NA; Valentine, V
Published in: Ann Thorac Surg
October 2011

BACKGROUND: Highly sensitized (HS) left ventricular assist device (LVAD) patients with high panel-reactive antibody (PRA) levels present a challenge. Alemtuzumab, a potent depleting agent for T and B lymphocytes (months to years), and plasmapheresis, offer an opportunity for heart transplantation to these patients who might die of VAD complications on the transplant waiting list. This study compared rates of acute rejection and survival of a HS LVAD cohort with a contemporaneous control group after heart transplant. METHODS: Clinical courses of 31 consecutive patients who underwent transplantation between January 2006 and January 2011 were reviewed. Eight patients with a T or B PRA of 70 or more (HS+) received non-crossmatched, ABO-compatible hearts using intraoperative plasmapheresis and alemtuzumab induction. Controls (HS-) received basiliximab induction. Acute rejection was defined as International Society for Heart and Lung Transplantation grades 2R or higher, or antibody-mediated rejection. RESULTS: The difference in survival between HS+ and HS- groups at 1 year (100% vs 94%) or at a mean follow-up of 2.3 and 2.4 years (75% vs 70%) was not significant. Retrospective lymphocytotoxic crossmatches were positive in 7 of 8 HS+ patients (6 T+ and B+, 1 B+) vs none in the HS- group (p < 0.001). There was a trend toward increased risk of cellular rejection per 100 patient-days beyond 1 year in the HS+ group (p = 0.07). Risk of humoral rejection was significantly increased in the HS+ group (38% vs 4%; p = 0.04). CONCLUSIONS: Heart transplantation with plasmapheresis and alemtuzumab in HS LVAD patients, most with a positive crossmatch, does not compromise midterm survival. The expected higher rates of rejection, especially beyond the first postoperative year, demand adjustments in surveillance strategies and immunosuppressive management.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2011

Volume

92

Issue

4

Start / End Page

1428 / 1434

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Texas
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Plasmapheresis
  • Middle Aged
  • Male
  • Intraoperative Care
 

Citation

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Lick, S. D., Beckles, D. L., Piovesana, G., Vaidya, S., Indrikovs, A., Barbagelata, N. A., & Valentine, V. (2011). Transplantation of high panel-reactive antibody left ventricular assist device patients without crossmatch using on-bypass pheresis and alemtuzumab. Ann Thorac Surg, 92(4), 1428–1434. https://doi.org/10.1016/j.athoracsur.2011.04.064
Lick, Scott D., Daniel L. Beckles, Giovanni Piovesana, Smita Vaidya, Alexander Indrikovs, N Alexander Barbagelata, and Vincent Valentine. “Transplantation of high panel-reactive antibody left ventricular assist device patients without crossmatch using on-bypass pheresis and alemtuzumab.Ann Thorac Surg 92, no. 4 (October 2011): 1428–34. https://doi.org/10.1016/j.athoracsur.2011.04.064.
Lick SD, Beckles DL, Piovesana G, Vaidya S, Indrikovs A, Barbagelata NA, et al. Transplantation of high panel-reactive antibody left ventricular assist device patients without crossmatch using on-bypass pheresis and alemtuzumab. Ann Thorac Surg. 2011 Oct;92(4):1428–34.
Lick, Scott D., et al. “Transplantation of high panel-reactive antibody left ventricular assist device patients without crossmatch using on-bypass pheresis and alemtuzumab.Ann Thorac Surg, vol. 92, no. 4, Oct. 2011, pp. 1428–34. Pubmed, doi:10.1016/j.athoracsur.2011.04.064.
Lick SD, Beckles DL, Piovesana G, Vaidya S, Indrikovs A, Barbagelata NA, Valentine V. Transplantation of high panel-reactive antibody left ventricular assist device patients without crossmatch using on-bypass pheresis and alemtuzumab. Ann Thorac Surg. 2011 Oct;92(4):1428–1434.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2011

Volume

92

Issue

4

Start / End Page

1428 / 1434

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Texas
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Plasmapheresis
  • Middle Aged
  • Male
  • Intraoperative Care