Pulmonary Hypertension, Panel-Reactive Antibodies, and Outcomes in LVAD-Bridged Heart Transplant

04 Mar 20264 min read0 viewsJournal Feed

GIST

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundPulmonary hypertension (PH) and sensitization adversely affect heart transplant outcomes.

Although left ventricular assist devices may reduce PH, they can increase sensitization. We examined the impact of sensitization on heart transplant outcomes in left ventricular assist device‐bridged patients and whether precapillary PH modifies this effect.MethodsAdults bridged to heart transplant with an left ventricular assist device between 2005 and 2020 were identified from the United Network for Organ Sharing database.

Patients with available panel‐reactive antibody (PRA) and hemodynamic data were included. Associations between PRA and survival and treated rejection were analyzed.ResultsAmong 2469 patients, 1053 had precapillary PH (pulmonary vascular resistance [PVR] >2 Wood units [WU]) and 1416 had PVR ≤2 WU.

Elevated PRA (>10%) occurred in 566 patients (24.8% with PVR >2 WU; 21.5% with PVR ≤2 WU).

Clinical Editorial

Signal Context and Study Rigor

The investigation uses a retrospective cohort drawn from the United Network for Organ Sharing database, focusing on adults bridged to heart transplantation with an LVAD from 2005 to 2020.
Inclusion required available panel-reactive antibody (PRA) and hemodynamic data to assess associations with survival and treated rejection.

Cohort Characteristics and Exposure Definitions

Total sample: 2,469 LVAD-bridged heart transplant recipients.
Precapsillary PH stratification: defined by pulmonary vascular resistance (PVR) greater than 2 Wood units (WU) in 1,053 patients, versus 1,416 patients with PVR ≤ 2 WU.
Sensitization exposure: elevated PRA, defined as PRA > 10%, observed in 566 participants (24.8% of the PVR >2 WU subgroup; 21.5% of the PVR ≤2 WU subgroup).

Primary Findings on Survival

Elevated PRA (>10%) correlated with higher overall mortality in the entire LVAD-bridged cohort.
The mortality association was particularly pronounced in those with precapillary PH (PVR >2 WU), where PRA >10% corresponded to a significantly increased adjusted hazard ratio for death.
In the PVR ≤2 WU subgroup, PRA >10% did not show a statistically significant impact on mortality.

Secondary Outcomes: Rejection Requiring Treatment

PRA >10% associated with higher odds of treated rejection across the total population.
The rejection signal was strongest in the PVR >2 WU group, with a notable increase in adjusted odds of treated rejection.
No significant association between PRA >10% and treated rejection emerged in the PVR ≤2 WU subgroup.