Abstract 4145503: The Trifecta of Female Gender, LVAD and Sensitization: A Case for Higher Priority Listing for Heart Transplant

Background: Highly sensitized recipients are expected to have higher wait-time for heart transplant, however, their sensitization status does not grant them higher priority. Methods: UNOS database was analyzed for adult heart transplant recipients from Oct 2018 to April 2024 with reported calculated panel reactive antibodies (cPRA). Retransplant and multiorgan transplant recipients were excluded. Results: Total 10801 recipients were identified. High cPRA (≥70% cPRA) group constituted only 5% of the listed patients. However, 13% of listed female recipients fell in this category (compared to <2% males, p <0.01). Higher cPRA recipients were more likely to have a durable LVAD (27% vs. 19%, p= 0.01). There was no difference in blood group O (p= 0.5), BMI (p=0.9) and dilated cardiomyopathy etiology (35% in both groups). High cPRA recipients were younger (51 vs. 53 years, p= 0.01). High cPRA group had significantly longer wait time (115 vs. 98 days, p= 0.04). Rejection episodes requiring treatment in the first year were similar (11% in both). One-year survival was comparable (figure). In median follow-up period of 720 days, hospitalization for rejection (3% vs. 4%, p= 0.3), for infection (11% vs. 10%, p= 0.3) and coronary artery vasculopathy rates were similar (4% vs. 6%, p= 0.4). Conclusion: High cPRA patients tend to be females, resulting in a gender disadvantage. Additionally, LVAD can be a source of ongoing but temporary sensitization, which could improve with its removal during transplant surgery. But due to their high cPRA, these LVAD patients will wait longer than non-sensitized LVAD patients, due to a significantly smaller donor pool. A case is made to consider adding higher priority status for high cPRA patients to balance the disadvantage in donor pool, without any effect on post-transplant mortality.