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

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.