Heart Transplantation (Videos Available)

Monday July 02, 2018 from 09:45 to 11:15

Room: N-112

323.3 HLA sensitization in end-stage heart failure patients supported by extracorporeal membrane oxygenation (Video Available)

Ozgur Ersoy, Turkey

Senior surgeon
Cardiovascular surgery
Baskent University

Abstract

HLA Sensitization in End-Stage Heart Failure Patients Supported By Extracorporeal Membrane Oxygenation

Anar Aliyev1, Ozgur Ersoy1, Bahadir Gultekin1, Sarp Beyazpinar1, Bilkay Basturk2, Atilla Sezgin1, Sait Aslamaci1.

1Cardiovascular Surgery, Baskent University, Ankara, Turkey; 2Immunology, Baskent University, Ankara, Turkey

Introduction: Human leukocyte antigen (HLA) sensitization of heart recipients increases the risk for dysfunction of the cardiac allograft. HLA sensitization rates on extracorporeal membrane oxygenation (ECMO) are unclear. In this retrospective study, we sought to define the possible factors that may induce HLA sensitization in the heart transplant recipients where ECMO bridge to transplantation was employed.
Materials and Methods: This was a single-center retrospective review in which 23 patients who were supported with ECMO were analyzed. Data on pre-transplant ECMO patients (14-51 years) included: age; diagnosis, duration of mechanical support; use of blood products, volume of transfusion; level of screening panel-reactive antibodies (PRAs); and outcome. PRA>25% was used to define HLA sensitization in both HLA type I and II while PRA>90% was used for highly-sensitized patients.
Results: 8 patients (34%) became sensitized after ECMO support. The duration of ECMO showed variation between 5 was 21 days. The volume of blood products transfused was 294 ml. Factors like; diagnosis, age and duration of mechanical support did not appear to be linked to HLA sensitization. However, the volume of transfused blood products has been found to be associated and could give rise to HLA sensitization. 
Conclusion: Different studies have shown an increased risk for acute graft failure among patients with elevated pre-transplant anti-HLA antibodies, but others have not. HLA sensitization does occur rarely in ECMO supported patients and may be associated with the large amounts of blood products received during ECMO. Although sensitization may occur, successful transplantation is possible without any evidence of rejection.  With increasing number of patients being bridged to heart transplantation, further research is needed to clearly define the significance of allosensitization on ECMO and establish a clear etiology of all factors related.



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