Does temporary mechanical circulatory support with Impella 5.5 induce de novo human leukocyte antigen antibodies production in heart transplantation candidates?
Amit Alam, MD,
Johanna S. van Zyl, PhD,
Staci McKean, MSN,
Ahmad B. Abdelrehim, MD,
Hira I. Shakoor, BS,
Dana Farsakh, MS,
Aayla K. Jamil, MBBS, MPH,
Joost Felius, PhD,
Medhat Askar, MD,
Shelley A. Hall, MD
Affiliations
Amit Alam, MD
Division of Cardiology, New York University Langone Health, New York, New York; Corresponding author: Amit Alam, MD, Langone Medical Center, Division of Cardiology, New York University, 530 First Avenue, Suite 9N, New York, NY.
Johanna S. van Zyl, PhD
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
Staci McKean, MSN
Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
Ahmad B. Abdelrehim, MD
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
Hira I. Shakoor, BS
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
Dana Farsakh, MS
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
Aayla K. Jamil, MBBS, MPH
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
Joost Felius, PhD
Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas
Medhat Askar, MD
Division of Cardiology, New York University Langone Health, New York, New York; Qatar University Health and Department of Immunology, College of Medicine, Qatar University, Doha, Qatar
Shelley A. Hall, MD
Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
Background: Little is known about de novo human luekocyte antigen (HLA) antibody development with Impella 5.5 temporary mechanical circulatory assist support and downstream effects following heart transplantation in the new heart allocation system. Methods: Thirteen Impella and 17 control patients without device support were prospectively enrolled between December 2020 and June 2022. HLA antibodies with calculated panel reactive antibodies (cPRA) were assessed pre and postdevice implantation and within 1-year postheart transplantation. Results: Baseline prevalence of HLA antibodies and median cPRA were similar between groups. Patients in the study arm were on Impella support for a median of 7 days. No significant differences in HLA antibodies were observed postdevice or postheart transplant. One patient in the Impella arm developed rejection and required treatment. One Impella patient died due to infection and 1 control patient died due to primary graft dysfunction. Conclusions: Short-term use of Impella 5.5 in the new heart allocation system does not appear to increase risk of de novo HLA antibody development. Further studies are needed to validate these preliminary findings.
