ABSTRACT
The purpose of this study was to evaluate sensitisation, occurring because of bridging with VAD, and development of rejection episodes after transplantation in selected groups of patients using triple drug immunosuppression, without induction or desensitisation therapy. Sensitisation using standard complement dependent cytotoxicity was tested in 16 patients awaiting cardiac transplantation before VAD placement, one month post-implantation and on a six-monthly basis later on. Long-term (955+/-998 days) post-transplant course of six transplanted post-VAD patients was compared with 19 non-bridged recipients (follow-up time 1425+/-1273 days) of the same age. One-third of VAD recipients had developed anti-HLA antibodies one month post-implantation; 4/16 patients were sensitised six months after implantation. No de novo sensitisation development was revealed in VAD group post-transplantation. All sensitised patients independent of VAD placement underwent graft rejection episodes. Only 1 of 6 VAD recipient was treated because of grade 2R rejection, compared to 6/19 in the non-bridged group, P=0.63. None of the patients had failed because of early graft rejection. In conclusion, VAD devices used in our centre cause low level risk for anti-HLA antibodies development. There were no differences in survival due to immunologic reasons between VAD bridged and non-bridged patients.
Subject(s)
Graft Rejection/prevention & control , Graft Survival/drug effects , HLA Antigens/immunology , Heart Failure/therapy , Heart Transplantation/adverse effects , Heart-Assist Devices/adverse effects , Immunosuppressive Agents/therapeutic use , Isoantibodies/blood , Adolescent , Adult , Aged , Antibody Formation/drug effects , Child , Child, Preschool , Desensitization, Immunologic , Drug Therapy, Combination , Female , Graft Rejection/immunology , Heart Failure/surgery , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome , Young AdultABSTRACT
The aim of present paper is to analyze immunological changes due to Ross operation. Cellular immune response as well as incidence of antibodies directed against human leukocyte antigens were studied in patients who received cardiac valve allografts. Standard microlymphocytotoxicity test was used to determine the percentage of panel reactive antibodies. Activated lymphocyte response to Pokeweed mitogen was revealed in patients after Ross operation. The panel reactive antibodies became positive in 3 out of 6 recipients tested. This production of donor specific anti-HLA antibodies can contribute to graft failure in case of subsequent cardiac transplantation.
