Successful heart transplant after 10 years of left ventricular assist device support in a highly sensitized patient

TL;DR

A woman who used a heart pump for 10 years successfully had a heart transplant despite a high risk of rejection.

Contribution

Demonstrates successful heart transplant after long-term LVAD use in a highly sensitized patient.

Findings

Heart transplantation was feasible after 10 years of LVAD support.

No acute rejection occurred post-transplant with proper management.

Multidisciplinary care was essential for a favorable outcome.

Abstract

Long-term left ventricular assist devices (LVAD) are an effective bridge-to-transplant strategy in end-stage heart failure. Prolonged device exposure may induce humoral activation, leading to anti-human leukocyte antigen (HLA) and non-HLA alloimmunization, complicating transplant access. We report a 43-year-old woman supported by a continuous-flow HeartWare ventricular assist device (HVAD) for 10 years, with severe anti-HLA hyperimmunization. She successfully underwent heart transplantation with stable hemodynamics, satisfactory early graft function, and no acute rejection. The postoperative course required multidisciplinary care, including hemodynamic, renal, respiratory, and infectious management, and evolved favorably. This case illustrates the feasibility of heart transplantation after prolonged LVAD support, even in highly sensitized patients, and highlights the importance of individualized immunological assessment and coordinated perioperative management.