Outcomes of Heart Transplant in a Sensitized Latin American Population

Purpose The presence of preformed antibodies (Ab) in heart transplant (HTx) candidates increase mortality while in the waiting list, and also graft rejection risk and post transplant mortality during short and long term follow-up. The purpose was to analyze the prevalence of sensitized patients (Sp) with positive panel-reactive antibody-PRA (+)-in a HTx p population at a single center, and its association with antibody-mediated rejection (AMR), development of coronary artery vasculopathy (CAV) and mortality. Methods All p with PRA (+) ≥10% were considered as Sp and their typification was evaluated. Up to 2012, the method of analysis used was cytotoxicity and afterwards the solid phase method (Luminex®). The organ allocation for all Sp was performed by prospective cross match after September 2015. Continuous variables were expressed by mean and standard or median deviation, and interquartile range and categorical variables, by absolute values and percentages. Survival was analyzed with Kaplan Meier method and compared with Long Rank test. A value of p Results Retrospective analysis of 538 p assesed for HTx between January 2008 to December 2018.; 292 p (54%) underwent HTx. Patients ≤18 years old, combined HTx and retransplant were excluded. The population was 250 p; 182 (73%) were men; age 49± 13 years, 120 p (48%) were in A and B emergency status (UNOS Stage 1 and 2). The prevalence of Sp was 6% (14p): Ab anti-HLA Class I 64 % (9p) and Class II 43% (6p). PRA (+) ≥80% was detected in 1p and PRA (+) ≥50 in 4 p. Induction treatment: corticosteroids, 14 p (100%); thymoglobulin, 6 p (43%) and plasmapheresis, 7 p (50%). Table 1 shows the incidence of AMR, ACR, CAV and inhospital mortality during follow up. Survival was not statistically significant at 1 and 5 years (p=08). Conclusion In the population analyzed, the presence of sensitization was associated with higher AMR and CAV, but not with a statistically significant increase in mortality.