HLA Alloimmunization Following Ventricular Assist Device Support Across the Age Spectrum

Abstract

Ventricular assist device (VAD) therapy has become an important tool for end-stage heart failure. VAD therapy has increased survival but is associated with complications including the development of human leukocyte antigen (HLA) antibodies. We sought to determine the incidence of HLA antibody development post-VAD insertion, across the age spectrum, in patients receiving leukocyte-reduced blood products, with standardized HLA antibody detection methods and to investigate factors associated with antibody development. This was a retrospective analysis of all patients who underwent durable VAD placement between 2005-2014. Inclusion criteria included availability of pre- and post-VAD HLA antibody results. Associations between HLA antibody development in the first year post implant and patient factors were explored. 39 adult and 25 pediatric patients made up the study cohort. Following implant, 31% and 8% of patients developed new Class I and Class II antibodies. The proportion of newly sensitized patients was similar in adult and pediatric patients. The Class I HLA panel reactive antibody (PRA) only significantly increased in adults. Pre-VAD sensitization, age, sex (pediatrics), and transfusion were not associated with the development of HLA antibodies. In a cohort of VAD patients receiving leukocyte-reduced blood products and standardized HLA antibody testing, roughly one-third developed new Class I antibodies in the first year post implant. Adults showed significantly increased Class I PRA following VAD support. No patient-related factors were associated with HLA antibody development. Larger prospective studies are required to validate these findings and determine the clinical impact of these antibodies following VAD insertion.