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| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Artículo Open Access |
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Wiley
2024
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| Online Access: | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15330 |
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- Bridge‐to‐transplant temporary mechanical circulatory support and risk of allosensitization Konstantinos Sideris Eszter Lázár‐Molnár Christos P. Kyriakopoulos Iosif Taleb Denise Hurst Sharon Ugolini Craig H. Selzman Lina Brinker Stavros G. Drakos Joseph E. Tonna Laura Geer Matthew L. Goodwin Omar Wever‐Pinzon Thomas C. Hanff James C. Fang Spencer Carter Josef Stehlik Clinical Transplantation AbstractIntroductionSince the 2018 change in the US adult heart allocation policy, more patients are bridged‐to‐transplant on temporary mechanical circulatory support (tMCS). Previous studies indicate that durable left ventricular assist devices (LVAD) may lead to allosensitization. The goal of this study was to assess whether tMCS implantation is associated with changes in sensitization.MethodsWe included patients evaluated for heart transplants between 2015 and 2022 who had alloantibody measured before and after MCS implantation. Allosensitization was defined as development of new alloantibodies after tMCS implant.ResultsA total of 41 patients received tMCS before transplant. Nine (22.0%) patients developed alloantibodies following tMCS implantation: 3 (12.0%) in the intra‐aortic balloon pump group (n = 25), 2 (28.6%) in the microaxial percutaneous LVAD group (n = 7), and 4 (44.4%) in the veno‐arterial extra‐corporeal membrane oxygenation group (n = 9)—p = .039. Sensitized patients were younger (44.7 ± 11.6 years vs. 54.3 ± 12.5 years, p = .044), were more likely to be sensitized at baseline ‐ 4 of 9 (44.4%) compared to 1 out of 32 (3.1%) (p = .001) and received more transfusions with red blood cells (6 (66.7%) vs. 8 (25%), p = .02) and platelets (6 (66.7%) vs. 5 (15.6%), p = .002). There was no significant difference in tMCS median duration of support (4 [3,15] days vs. 8.5 [5,14.5] days, p = .57). Importantly, out of the 11 patients who received a durable LVAD after tMCS, 5 (45.5%) became sensitized, compared to 4 out of 30 patients (13.3%) who only had tMCS—p = .028.ConclusionsOur findings suggest that patients bridged‐to‐transplant with tMCS, without significant blood product transfusions and a subsequent durable LVAD implant, have a low risk of allosensitization. Further studies are needed to confirm our findings and determine whether risk of sensitization varies by type of tMCS and duration of support. 10.1111/ctr.15330 http://creativecommons.org/licenses/by-nc/4.0/