The risk of coronary transplant vasculopathy in the patient bridged with a ventricular assist device

O343* Aims: A common consequence of left ventricular assist device (LVAD) implantation is the development of anti-HLA alloantibodies. While alloantibodies have been shown to be associated to vascular rejection the ultimate impact on vasculopathy is still ill defined. Previously observed the presence of Class I anti-HLA donor reactive antibodies was associated with significant early post-transplant vasculopathy. To examine this we obtained coronary angiograms from 196 patients bridged with LVAD and compared their post transplant coronary angiograms to a non-LVAD cohort (n=112) examined in a previous study. Methods: Adult patients undergoing orthotopic heart transplant between 1999-2000 were retrospectively studied and compared to our LVAD population. Coronary angiograms were retrospectively reviewed and severity of coronary vasculopathy was categorized as either normal, mild, moderate or severe. Other variables studied included cytotoxic panel reactive antibodies (PRA) against T-cell targets and flow cytometric crossmatching against donor t lymphocytes. Results: As anticipated there was an increase sensitization in those patients receiving a LVAD. Twenty-one percent of LVAD patients had a T-cell PRA greater than 10% at the time of transplant compared to 3.6% of the controls (p<0.0001, Fishers exact). Likewise, 25% of the LVAD patients had positive T-cell flow crossmatches compared to 5.4% of the controls (p<0.0001). Despite this coronary angiograms revealed no significant difference in the degree of coronary vasculopathy between the groups at follow-up. Normal coronary anatomy was detected in 72.5 % of LVAD patients and 64.6% of non-LVAD patients (p=0.79). These results were nearly identical at 2- and 3- year follow-up (71.8% vs. 64.6% and 58.3% vs.59.7%). Conclusions: While preoperative LVAD use is associated with a risk of recipient sensitization these patients develop transplant vasculopathy at the same rate as those not receiving a LVAD.