{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:02:53Z","timestamp":1793250173383,"version":"4.5.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The development of human leukocyte antigen (HLA) antibodies poses a major challenge in transplantation by limiting donor compatibility and increasing the risk of graft failure. In patients with advanced heart failure, ventricular assist devices (VADs) are frequently used as a bridge to transplantation and often necessitate perioperative blood transfusions, a recognized trigger for HLA sensitization. However, the risk factors, timing, and clinical relevance of transfusion-induced HLA antibodies in VAD recipients remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 60 adult heart transplant candidates who underwent VAD implantation and received blood transfusions. HLA antibody profiles were assessed at three time points: pre-VAD implantation, post-VAD\/pre-transplantation, and post-transplantation. Patients were categorized according to the number of newly detected HLA antibodies following VAD implantation as non-producers (NP; no new antibodies), low producers (LP; 1\u201310 antibodies), or high producers (HP; &amp;gt;10 antibodies). Associations between antibody development and demographic characteristics, transfusion exposure, pre-existing sensitization, antibody persistence, and transplant outcomes were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following VAD implantation, 73% of patients developed new HLA antibodies, with 65% of these antibodies emerging during the post-VAD\/pre-transplant interval. Patient distribution was 35.0% NP, 51.7% LP, and 13.3% HP. Age, ethnicity, and transplant rates were comparable across groups; however, females were disproportionately represented in the HP group (75%, 6 of 8). Neither the number nor the type of blood products transfused was associated with antibody development. The majority of transfusion-associated HLA antibodies were transient, declining rapidly and rarely recurring after transplantation. In contrast, persistent antibodies were predominantly pre-existing and were more frequently observed in female patients, consistent with prior sensitization events such as pregnancy. Notably, unsensitized male patients demonstrated minimal antibody formation following transfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings indicate that transfusion-induced HLA antibodies in VAD recipients are generally transient and lack durable serologic significance, with little evidence of post-transplant rebound. In contrast, sustained alloimmune responses are primarily driven by pre-existing sensitization, particularly pregnancy-related exposure in female patients. These results support a more individualized approach to HLA antibody surveillance and virtual crossmatching, especially in patients with limited transfusion exposure and no prior sensitization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1729124","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:35:52Z","timestamp":1768973752000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Transfusion-induced HLA antibodies are short-lived and rarely recur post-heart transplantation: a single-center retrospective study with implications for virtual crossmatching"],"prefix":"10.3389","volume":"17","author":[{"given":"Raja","family":"Rajalingam","sequence":"first","affiliation":[{"name":"Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stalinraja","family":"Maruthamuthu","sequence":"additional","affiliation":[{"name":"Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian R.","family":"Shy","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Cunniffe","sequence":"additional","affiliation":[{"name":"Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lowe","sequence":"additional","affiliation":[{"name":"Heart Transplant and Mechanical Circulatory Support Program, Department of Surgery, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Othman A.","family":"Aljohani","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Wieselthaler","sequence":"additional","affiliation":[{"name":"Heart Transplant and Mechanical Circulatory Support Program, Department of Surgery, University of California, San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1016\/j.jtcvs.2011.07.019","article-title":"Effect of sensitization in us heart transplant recipients bridged with a ventricular assist device: update in a modern cohort","volume":"142","author":"Arnaoutakis","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2013.08.014","article-title":"Hla and mica allosensitization patterns among patients supported by ventricular assist devices","volume":"32","author":"Askar","year":"2013","journal-title":"J Heart Lung Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1016\/j.jtcvs.2010.04.009","article-title":"Impact of antibodies against human leukocyte antigens on long-term outcome in pediatric heart transplant patients: an 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to heart transplantation using ventricular assist device","volume":"34","author":"Elkind","year":"2020","journal-title":"Clin Transplant"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002798","article-title":"Hla alloimmunization following ventricular assist device support across the age spectrum","volume":"103","author":"Halpin","year":"2019","journal-title":"Transplantation"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000053","article-title":"Human leukocyte antigen sensitization in pediatric patients exposed to mechanical circulatory support","volume":"60","author":"Hong","year":"2014","journal-title":"ASAIO J"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gft362","article-title":"Sensitization from transfusion in patients awaiting primary kidney transplant","volume":"28","author":"Yabu","year":"2013","journal-title":"Nephrol Dial Transplant"}],"container-title":["Frontiers in 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