(1040) Impact of Lymphocyte-Depleting Induction on Graft Outcomes in Highly Sensitized Heart Transplant Recipients

PurposeAllosensitization is associated with post-transplant complications in heart transplant (HT) recipients. Lymphocyte-depleting induction may mitigate these risks, but efficacy data conflicting.MethodsThis single center, retrospective cohort study compared highly sensitized HT recipients (cPRA ≥50%) receiving lymphocyte-depleting vs. no from 2015-2021. The primary outcome was a composite of high-grade biopsy-proven acute rejection (BPAR) defined as ISHLT ≥2R rejection, and death at 12 months.ResultsOf the 53 patients identified, 25 received (16 anti-thymocyte globulin [rATG] 9 alemtuzumab). Baseline demographics were similar between groups except higher prevalence renal dysfunction group (p=0.002). There significant difference endpoint (HR, 0.16; 95% CI, 0.02-1.34; p=0.09). lower hazard any BPAR 0.27; 0.10-0.76; p=0.01). This driven by rates cellular control arm (p=0.02).ConclusionLymphocyte depleting resulted less confers statistically benefit early or reduction month mortality. Allosensitization conflicting. months. Of (p=0.02). Lymphocyte