Cardiac allograft rejection in the current era of continuous flow left ventricular assist devices
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
OBJECTIVE: Left ventricular assist device (LVAD) implantation has been shown to increase allosensitization before orthotopic heart transplantation, but the influence of LVAD support on posttransplant rejection is controversial. This study examines the postoperative incidence of acute cellular rejection (ACR) in patients bridged with continuous flow LVAD (CF-LVAD) relative to primary transplant (Primary Tx).
METHODS: All patients who underwent orthotopic heart transplantation at our institution between July 2006 and March 2019 were retrospectively reviewed (n = 395). Patients were classified into Primary Tx (n = 145) and CF-LVAD (n = 207) groups. Propensity score matching on 13 covariates implemented a 0.1 caliper logistic model with nearest neighbor 1:1 matching. Development of moderate to severe (ie, 2R/3R) rejection was evaluated using a competing risks model. Potential predictors of 2R/3R ACR were evaluated using Fine-Gray regression on the marginal subdistribution hazard.
RESULTS: Propensity score matching yielded 122 patients in each group (n = 244). At 12 and 24 months, the cumulative incidence of 2R/3R ACR was 17% and 23% for the CF-LVAD group and 26% and 31%, respectively, for the Primary Tx group (P = .170). CF-LVAD was not predictive of 2R/3R rejection on multivariable Fine-Gray regression (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.40-1.33; P = .301). There was no difference in the 5-year incidence of antibody mediated rejection (10% [n = 12] vs 9% [n = 11]; P = .827).
CONCLUSIONS: After adjusting for covariates, CF-LVAD was not associated with an increased risk of moderate to severe ACR during the 24 months after cardiac transplantation. Further investigation is warranted with larger cohorts, but CF-LVAD may have minimal influence on posttransplant ACR.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2022 Jan;163(1):135-136. - PMID 32741633 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:163 |
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| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 163(2022), 1 vom: 15. Jan., Seite 124-134.e8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bakir, Nadia H [VerfasserIn] |
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| Links: |
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| Themen: |
Antibodies |
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| Anmerkungen: |
Date Completed 26.01.2022 Date Revised 26.01.2022 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2022 Jan;163(1):135-136. - PMID 32741633 Citation Status MEDLINE |
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| doi: |
10.1016/j.jtcvs.2020.06.142 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315828285 |
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| 100 | 1 | |a Bakir, Nadia H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cardiac allograft rejection in the current era of continuous flow left ventricular assist devices |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 26.01.2022 | ||
| 500 | |a Date Revised 26.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2022 Jan;163(1):135-136. - PMID 32741633 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: Left ventricular assist device (LVAD) implantation has been shown to increase allosensitization before orthotopic heart transplantation, but the influence of LVAD support on posttransplant rejection is controversial. This study examines the postoperative incidence of acute cellular rejection (ACR) in patients bridged with continuous flow LVAD (CF-LVAD) relative to primary transplant (Primary Tx) | ||
| 520 | |a METHODS: All patients who underwent orthotopic heart transplantation at our institution between July 2006 and March 2019 were retrospectively reviewed (n = 395). Patients were classified into Primary Tx (n = 145) and CF-LVAD (n = 207) groups. Propensity score matching on 13 covariates implemented a 0.1 caliper logistic model with nearest neighbor 1:1 matching. Development of moderate to severe (ie, 2R/3R) rejection was evaluated using a competing risks model. Potential predictors of 2R/3R ACR were evaluated using Fine-Gray regression on the marginal subdistribution hazard | ||
| 520 | |a RESULTS: Propensity score matching yielded 122 patients in each group (n = 244). At 12 and 24 months, the cumulative incidence of 2R/3R ACR was 17% and 23% for the CF-LVAD group and 26% and 31%, respectively, for the Primary Tx group (P = .170). CF-LVAD was not predictive of 2R/3R rejection on multivariable Fine-Gray regression (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.40-1.33; P = .301). There was no difference in the 5-year incidence of antibody mediated rejection (10% [n = 12] vs 9% [n = 11]; P = .827) | ||
| 520 | |a CONCLUSIONS: After adjusting for covariates, CF-LVAD was not associated with an increased risk of moderate to severe ACR during the 24 months after cardiac transplantation. Further investigation is warranted with larger cohorts, but CF-LVAD may have minimal influence on posttransplant ACR | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a competing risks | |
| 650 | 4 | |a heart transplant | |
| 650 | 4 | |a left ventricular assist device | |
| 650 | 4 | |a rejection | |
| 650 | 7 | |a Antibodies |2 NLM | |
| 700 | 1 | |a Finnan, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a MacGregor, Robert M |e verfasserin |4 aut | |
| 700 | 1 | |a Schilling, Joel D |e verfasserin |4 aut | |
| 700 | 1 | |a Ewald, Gregory A |e verfasserin |4 aut | |
| 700 | 1 | |a Kotkar, Kunal D |e verfasserin |4 aut | |
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| 700 | 1 | |a Masood, Muhammad F |e verfasserin |4 aut | |
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