The impact of HLA sensitization and donor cause of death in heart transplantation

Current expansion of the recipient population and increased utilization of left ventricular assist devices as a bridge-to transplantation have resulte d in HLA sensitization becoming an increasingly important clinical problem in cardiac transplantation. We evaluated the impact of HLA sensitization an d donor cause of death on survival in 500 cardiac transplant recipients. Do nor cause of death tvas grouped into two categories, trauma and nontrauma. Panel reactive anti-bodies at the time of transplant were assayed and used as a marker for sensitization if more than 10%. Sensitized recipients had a poorer 1-year survival than those not sensitized (76 vs. 89%, respectively , P=0.2). Donor cause of death had an overall significant impact on surviva l with 1-year survival for recipients of trauma organs of 92 and 82% for re cipients of nontrauma hearts (P=0.02). Trauma hearts transplanted into sens itized recipients yielded a survival of 93% at 1 year whereas if nontrauma donor hearts were transplanted into these recipients, survival was only 52% at 1 year, P<0.001. These intriguing results suggest that graft survival i n HLA-sensitized recipients could be significantly improved through the use of hearts from trauma death donors.