Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
Transplantation. 2019 Dec;103(12):2715-2724. doi: 10.1097/TP.0000000000002798.
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 and 2014. Inclusion criteria included availability of pre- and post-VAD HLA antibody results. Associations between HLA antibody development in the first-year postimplant and patient factors were explored.
Thirty-nine 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 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 postimplant. Adults showed significantly increased class I panel reactive antibody 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.
心室辅助装置（VAD）治疗已成为终末期心力衰竭的重要手段。VAD 治疗提高了生存率，但与包括人类白细胞抗原（HLA）抗体发展在内的并发症相关。我们旨在确定在接受白细胞减少血液制品的患者中，在 VAD 插入后跨年龄谱 HLA 抗体发展的发生率，使用标准化 HLA 抗体检测方法，并调查与抗体发展相关的因素。
这是一项对 2005 年至 2014 年间接受耐用 VAD 植入术的所有患者进行的回顾性分析。纳入标准包括 VAD 前后 HLA 抗体结果的可用性。探讨了植入后第一年 HLA 抗体发展与患者因素之间的关联。
研究队列包括 39 名成年患者和 25 名儿科患者。植入后，31%和 8%的患者分别发展出新的 class I 和 class II 抗体。成年和儿科患者中新致敏患者的比例相似。只有 class I HLA 面板反应性抗体在成年患者中显著增加。VAD 前致敏、年龄、性别（儿科）和输血与 HLA 抗体的发展无关。
在接受白细胞减少血液制品和标准化 HLA 抗体检测的 VAD 患者队列中，约有三分之一的患者在植入后第一年出现新的 class I 抗体。成人在接受 VAD 支持后，class I 面板反应性抗体显著增加。没有患者相关因素与 HLA 抗体发展相关。需要更大的前瞻性研究来验证这些发现，并确定这些抗体在 VAD 插入后的临床影响。
