Apheresis Platelets Reduce De Novo HLA Antibody Formation After Heart Transplantation: Real World Data from a Retrospective Multicenter Study

Abstract

Nicole Bewersdorf, Adrian Stephan, Charlotte Lachauer, Dania Fischer, Markus Alexander Weigand, Christine-Elena Kamla, Vincent Hettlich, Udo Boeken, Till Hoffmann, Matthias Karck, Albrecht Leo, Wiebke Sommer and Andrea Dick

De novo development of human leukocyte antigen (HLA) antibodies remains a significant challenge in heart transplant (HTx) recipients. Despite advances in perioperative management and immunosuppressive therapy, HLA sensitization continues to contribute to graft dysfunction, rejection, and reduced survival. Beyond investigating the immunogenic impact of pooled versus apheresis-derived platelets, this study provides real-world epidemiological data on the current transfusion practices in this high-risk cohort.

Design: We conducted a retrospective, multicenter cohort study with approval from the ethics committees of all participating institutions.

Setting: The study took place at three German university hospitals (Heidelberg, Munich and Düsseldorf) between December 2011 and December 2021.

Participants: Eligible participants were adult patients aged 18 years or older who underwent HTx and provided written informed consent.

Interventions: The study among others investigates the type of platelet transfusion received, evaluating its association with the development and progression of HLA antibodies within one year following HTx.

Measurements and Main Results: A total of 223 patients were included (median age 54 [IQR 46–60] years; 37% female). Ten patients received pooled platelet concentrates (PPC), and 167 received apheresis platelet concentrates (APC) intraoperatively. Within one year, 70% (n = 7) of PPC recipients developed de novo HLA antibodies compared to 28% (n = 46) of APC recipients.

Conclusions: Analysis of real-world hospital data suggests an increased risk of HLA sensitization associated with pooled platelet concentrate transfusions. These findings might indicate that, in routine clinical practice, the preferential use of apheresis platelets during heart transplantation may help reduce alloimmunization risk and potentially may improve long-term outcomes.

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