Comparable Waiting Time for Highly Sensitized Patients Awaiting Heart Transplant Using Desensitization Therapy and the Virtual Crossmatch
J. Kobashigawa, M. Kittleson, M. Rafiei, A. Osborne, D. Chang, L. Czer, N. Reinsmoen, J. Patel
Cedars-Sinai Heart Institute, Los Angeles, CA
Abstract number: C1440
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BACKGROUND: Highly sensitized patients (pts) awaiting heart transplant (HTx) face many obstacles. These pts have a reported longer waiting time to obtain a compatible donor and also run the risk of increased complications while on the waitlist due to longer waiting times. Desensitization therapies have been used in this pt population w/ newer drugs such as bortezomib being more efficacious. It has not been clearly established the outcome of these pts following HTx. We sought to evaluate highly sensitized pts (PRA≥70%) to assess effects of desensitization and virtual crossmatch on post-HTx outcomes.
METHODS: Between 2006 and 2011, we evaluated 230 pts on the HTx waiting list. Pts were divided into those that were highly sensitized (PRA≥70%), those w/moderate antibodies (PRA 40-70%), those w/mild antibodies (PRA 10-39%) and finally to those w/PRA<10%. End points include time on HTx waiting list and 1-year survival, freedom from antibody mediated rejection and from treated cellular rejection.
RESULTS: 69% of pts in the high PRA group received desensitization therapy vs 0-15% in the lower groups. Time on the waitlist was similar among all 3 groups with a large standard deviation. 1-year freedom from antibody-mediated and cellular rejection was significantly lower in the high PRA groups compared to the other 3 PRA groups however, 1-year survival was similar in all 3 groups.
|Endpoints||PRA 0%-9% (N=148)||PRA 10%-39% (N=34)||PRA 40%-70% (N=18)||PRA > 70% (N=30)|
|Time on Waitlist, Mean Days±SD||86±202 (118/148)||104±170 (32/34)||122±322 (17/18)||64±89 (28/30)|
|Desensitized, n (%)||3/86 (4%)||0/16 (0%)||2/13 (15%)||18/26 (69%)*,**,***|
|Received Induction Therapy, n (%)||50/125 (40%)||24/32 (75%)*||14/17 (82%)*||26/30 (87%)*|
|1-Year Survival, n (%)||143 (97%)||32 (94%)||17 (94%)||27 (90%)|
|Treated AMR in the 1st Year, n (%)||7 (5%)||2 (6%)||1 (6%)||5 (17%)*|
|Treated Cellular Rejection in the 1st Year, n (%)||12 (8%)||2 (6%)||2 (11%)||6 (20%)*|
**p<0.05 compared to pre-transplant PRA 10%-39% group
***p<0.05 compared to pre-transplant PRA 40%-70% group
CONCLUSION: Desensitization therapy and use of the virtual crossmatch in highly sensitized pts have resulted in comparable time on the waitlist compared to lower PRA groups without desensitization. For these highly sensitized pts, 1 year survival after HTx appears comparable despite increase in antibody-mediated and cellular rejection.
Kobashigawa, J.: Grant/Research Support, Novartis Pharma, Other, Novartis Pharma, Data Safety Monitoring Board. Reinsmoen, N.: Speaker’s Bureau, One Lambda. Patel, J.: Grant/Research Support, Alexion Pharma.
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