Three year post heart transplant outcomes of desensitized durable mechanical circulatory support patients.

May 08, 2023

Experts: Jong-Chan Youn,Darae Kim,Mi-Hyang Jung,Jin-Jin Kim,In-Cheol Kim,Hye Sun Lee,Jin-Oh Choi,Eun-Seok Jeon,Keith Nishihara,Osamu Seguchi,Evan P Kransdorf,David H Chang,Michelle M Kittleson,Jignesh K Patel,Robert M Cole,Jaime D Moriguchi,Danny Ramzy,Fardad Esmailian,Jon A Kobashigawa

The risk and benefit of desensitization therapy (DST) in highly sensitized mechanical circulatory support (MCS) patients are not well known. We investigated three year post-transplant outcome of desensitized durable MCS patients.
Among 689 consecutively enrolled HTx recipients between 2010 and 2016, we categorized them into Group A (desensitized MCS patients, n = 21), Group B (desensitized non-MCS patients, n = 28) and Group C (all non-desensitized patients, n = 640). Post-transplant outcomes included the incidence of primary graft dysfunction (PGD), 3-year survival, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), any treated rejection (ATR), acute cellular rejection (ACR), antibody mediated rejection (AMR) and infectious complications.
The types of DST in Groups A and B were similar and included combinations of rituximab/IVIG and plasmapheresis/bortezomib. Group A, compared with Group B, showed significantly higher pre-DST PRA (92.2 ± 9.8 vs. 83.3 ± 15.6, P = 0.007) and higher PRA reduction after DST (-22.2 ± 26.9 vs. -6.3 ± 7.5, P = 0.015). Groups A and C showed comparable PGD, 3-year survival, freedom from CAV, NF-MACE, ATR, ACR and AMR. Although statistically not significant, Group A showed a numerically higher 3-year freedom from AMR than Group B. Infectious complications were similar in both Groups A and B.
DST for MCS patients showed significant PRA reduction, resulting in an expansion of the donor pool. Post-transplant outcome of desensitized MCS patients showed comparable clinical outcome to non-desensitized control patients in the same study period, revealing the safety and efficacy of DST.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Jong-Chan Youn,Darae Kim,Mi-Hyang Jung,Jin-Jin Kim,In-Cheol Kim,Hye Sun Lee,Jin-Oh Choi,Eun-Seok Jeon,Keith Nishihara,Osamu Seguchi,Evan P Kransdorf,David H Chang,Michelle M Kittleson,Jignesh K Patel,Robert M Cole,Jaime D Moriguchi,Danny Ramzy,Fardad Esmailian,Jon A Kobashigawa

Jong-Chan Youn

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: jong.chan.youn@gmail.com.

Darae Kim

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Mi-Hyang Jung

Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Jin-Jin Kim

Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

In-Cheol Kim

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.

Hye Sun Lee

Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.

Jin-Oh Choi

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Eun-Seok Jeon

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Keith Nishihara

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Osamu Seguchi

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.

Evan P Kransdorf

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

David H Chang

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Michelle M Kittleson

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Jignesh K Patel

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Robert M Cole

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Jaime D Moriguchi

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Danny Ramzy

Department of Cardiothoracic Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Fardad Esmailian

Department of Cardiothoracic Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Jon A Kobashigawa

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: kobashigawaj@cshs.org.