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DOI: 10.1055/s-0030-1268995
Detection of anti-HLA and MICA antibodies in patients with ventricular assist device support
Objective: Patients who were bridged to transplantation with ventricular assist device (VAD) have a higher incidence for the development of antibodies directed against human-leukocyte-antigens (HLA) or against major-histocompatibility-complex-class I related chain A (MICA). HLA- and MICA-antibodies have been associated with acute and chronic rejection leading to decreased survival after heart transplantation. Up to now, monitoring of these clinical relevant antibodies is not an established routine.
Methods: Sera of 15 patients who underwent VAD implantation were analyzed by Luminex-technology for anti-HLA and anti-MICA antibodies. Blood transfusion history, gender, age and panel reactive antibody (PRA) level before VAD implantation were reviewed.
Results: The mean age was 51.1±11.6 years and the group consist of 12 men. The 3 women were pre-operatively HLA I or II positive. Regarding age, gender and number of received blood transfusions no significant differences were obtained between HLA/MICA-positive and HLA/MICA-negative patients. Seven of 15 patients (47%) showed anti-HLA and/or anti-MICA antibodies after VAD implantation, whereas 3 patients (20%) developed de novo antibodies against HLA class I, HLA class II and/or MICA antigens.
Conclusions: Patients with implanted VADs prior to transplantation have a higher risk to develop alloreactive antibodies because of the necessity of high amount of blood transfusion, but also due to the VAD itself. Due to increasing numbers of VAD implantations in consequence of missing donor hearts antibody monitoring and pre-operative intervention may be useful for better transplantation outcome.