TY - JOUR
T1 - HLA and MICA allosensitization patterns among patients supported by ventricular assist devices
AU - Askar, Medhat
AU - Hsich, Eileen
AU - Reville, Patrick
AU - Nowacki, Amy S.
AU - Baldwin, William
AU - Bakdash, Suzanne
AU - Daghstani, Jenna
AU - Zhang, Aiwen
AU - Klingman, Lynne
AU - Smedira, Nicholas
AU - Moazami, Nader
AU - Taylor, David O.
AU - Starling, Randall C.
AU - Gonzalez-Stawinski, Gonzalo
PY - 2013/12
Y1 - 2013/12
N2 - Background Ventricular assist devices (VADs) are increasingly being used as a bridge to transplantation and have been implicated as a risk factor for allosensitization to human leukocyte antigens (HLA). We investigate the association between VAD and allosensitization to human leukocyte antigens (HLA) and major-histocompatibility-complex (MHC) class I-related Chain A (MICA) antigens. Methods We considered all patients who received a VAD at our institution between 2000 and 2009; 89 of them had pre-VAD and post-VAD (≤6 months after implant) HLA antibody screening. A control group of non-VAD heart transplant candidates was constructed with at least 2 pre-transplant panel-reactive antibody (PRA) tests within 8 months. Two controls were randomly selected/VAD patient matched for year (n = 178). Patients and controls with available sera from these time-points were tested by Luminex/flow PRA single-antigen beads and by MICA antibody Luminex single-antigen beads. Medical records were reviewed for comparison of pre-transplant immunologic risk factors and post-transplant outcomes between the 2 groups. Results Compared with controls, VAD patients had greater Class I differences between peak and initial PRA (18% vs 0%, p < 0.0001) and higher peak PRA (24% vs 6%, p < 0.0001). The differences between the 2 groups in Class II were less pronounced than in Class I. Of patients who had single-antigen testing, VAD implantation was significantly associated with development of new HLA antibody specificities (Class I and/or Class II) post-VAD with an increase in calculated PRA (cPRA) post-VAD compared with controls (16% vs 0%, p < 0.0001). This risk was still present after adjusting for age, gender, pre-VAD PRA, transfusion and duration of follow-up in a multivariate analysis (p < 0.0001 and 0.02, respectively). There were no differences in development of MICA antibodies between the 2 groups (14% in both). There was no significant difference in the incidence of pre-transplant positive T-cell crossmatch, pre-transplant donor-specific HLA antibodies, rejection episodes or graft survival between the 2 groups. Conclusion Our results suggest that VAD is associated with significant HLA allosensitization independent of common risk factors.
AB - Background Ventricular assist devices (VADs) are increasingly being used as a bridge to transplantation and have been implicated as a risk factor for allosensitization to human leukocyte antigens (HLA). We investigate the association between VAD and allosensitization to human leukocyte antigens (HLA) and major-histocompatibility-complex (MHC) class I-related Chain A (MICA) antigens. Methods We considered all patients who received a VAD at our institution between 2000 and 2009; 89 of them had pre-VAD and post-VAD (≤6 months after implant) HLA antibody screening. A control group of non-VAD heart transplant candidates was constructed with at least 2 pre-transplant panel-reactive antibody (PRA) tests within 8 months. Two controls were randomly selected/VAD patient matched for year (n = 178). Patients and controls with available sera from these time-points were tested by Luminex/flow PRA single-antigen beads and by MICA antibody Luminex single-antigen beads. Medical records were reviewed for comparison of pre-transplant immunologic risk factors and post-transplant outcomes between the 2 groups. Results Compared with controls, VAD patients had greater Class I differences between peak and initial PRA (18% vs 0%, p < 0.0001) and higher peak PRA (24% vs 6%, p < 0.0001). The differences between the 2 groups in Class II were less pronounced than in Class I. Of patients who had single-antigen testing, VAD implantation was significantly associated with development of new HLA antibody specificities (Class I and/or Class II) post-VAD with an increase in calculated PRA (cPRA) post-VAD compared with controls (16% vs 0%, p < 0.0001). This risk was still present after adjusting for age, gender, pre-VAD PRA, transfusion and duration of follow-up in a multivariate analysis (p < 0.0001 and 0.02, respectively). There were no differences in development of MICA antibodies between the 2 groups (14% in both). There was no significant difference in the incidence of pre-transplant positive T-cell crossmatch, pre-transplant donor-specific HLA antibodies, rejection episodes or graft survival between the 2 groups. Conclusion Our results suggest that VAD is associated with significant HLA allosensitization independent of common risk factors.
KW - Allosensitization
KW - Antibody detection
KW - Heart transplantation
KW - Hla antibodies
KW - Mica antibodies
KW - Vad
UR - http://www.scopus.com/inward/record.url?scp=84888006401&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84888006401&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2013.08.014
DO - 10.1016/j.healun.2013.08.014
M3 - Article
C2 - 24075503
AN - SCOPUS:84888006401
SN - 1053-2498
VL - 32
SP - 1241
EP - 1248
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 12
ER -