The impact of Angiotensin II Type 1 Receptor antibodies on morbidity and mortality in Heart Mate II supported recipients
Abstract
AIMS: One of the proposed limitations of left ventricular assist device (LVAD) therapy is high degree of sensitization. Apart from human leukocyte antigen (HLA), antibodies against Angiotensin II Type 1 Receptor (AT1R) have been associated with adverse outcomes.
The purpose of this study was to compare complications and survival of anti - AT1R positive versus negative Heart Mate II (HMII) recipients. METHODS: Altogether 96 patients received HMII at our institution between 2008 and 2012.
These were stratified into three groups: antibody positive before implantation (AT1R+), antibody conversion during support (AT1R-/+) and patients who remained antibody negative (AT1R-). Survival, major on-device adverse events and post-transplant rejections were assessed with Kaplan-Meier and log-rank tests.
RESULTS: Two year on-device and overall survival was 78 +- 12% and 75 +- 10% in AT1R-, 60 +- 23% and 60 +- 15% in AT1R+ and 92 +- 6% and 87 +- 5% in AT1R-/+ group (P = 0.409, P = 0.185). Freedom from major adverse event at two years for AT1R-, AT1R+ and AT1R-/+ was 49 +- 14%, 53 +- 16% and 41 +- 11% (P = 0.875).
Freedom from rejection was 63 +- 17% in patients who were both anti-AT1R and HLA negative and 65 +- 13% in those who were antibody positive (P = 0.788). CONCLUSION: Patients who were anti-AT1R antibody positive had similar on-device survival and rate of complications in comparison to those who were antibody negative.
In transplanted patients, there were no differences in the overall survival and rejection between the groups.