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

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.