Alam Amit, van Zyl Johanna S, McKean Staci, Abdelrehim Ahmad B, Shakoor Hira I, Farsakh Dana, Jamil Aayla K, Felius Joost, Askar Medhat, Hall Shelley A
Division of Cardiology, New York University Langone Health, New York, New York.
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas.
JHLT Open. 2024 Feb 16;4:100072. doi: 10.1016/j.jhlto.2024.100072. eCollection 2024 May.
Little is known about de novo human luekocyte antigen (HLA) antibody development with Impella 5.5 temporary mechanical circulatory assist support and downstream effects following heart transplantation in the new heart allocation system.
Thirteen Impella and 17 control patients without device support were prospectively enrolled between December 2020 and June 2022. HLA antibodies with calculated panel reactive antibodies (cPRA) were assessed pre and postdevice implantation and within 1-year postheart transplantation.
Baseline prevalence of HLA antibodies and median cPRA were similar between groups. Patients in the study arm were on Impella support for a median of 7 days. No significant differences in HLA antibodies were observed postdevice or postheart transplant. One patient in the Impella arm developed rejection and required treatment. One Impella patient died due to infection and 1 control patient died due to primary graft dysfunction.
Short-term use of Impella 5.5 in the new heart allocation system does not appear to increase risk of de novo HLA antibody development. Further studies are needed to validate these preliminary findings.
在新的心脏分配系统中，关于使用Impella 5.5临时机械循环辅助支持后人体白细胞抗原（HLA）新抗体的产生以及心脏移植后的下游影响，人们了解甚少。
2020年12月至2022年6月期间，前瞻性纳入了13例使用Impella的患者和17例无设备支持的对照患者。在设备植入前后以及心脏移植后1年内，评估具有计算得出的群体反应性抗体（cPRA）的HLA抗体。
两组之间HLA抗体的基线患病率和cPRA中位数相似。研究组患者使用Impella支持的中位时间为7天。在设备植入后或心脏移植后，未观察到HLA抗体有显著差异。Impella组中有1例患者发生排斥反应并需要治疗。1例使用Impella的患者死于感染，1例对照患者死于原发性移植物功能障碍。
在新的心脏分配系统中短期使用Impella 5.5似乎不会增加HLA新抗体产生的风险。需要进一步研究来验证这些初步发现。
