Detection and management of HLA sensitization in candidates for adult heart transplantation

DeFilippis, Ersilia M.; Kransdorf, E.; Jaiswal, Abhishek; Zhang, Xiaohai; Patel, J.; Kobashigawa, Jon A.; Baran, David A.; Kittleson, M.

doi:10.1016/j.healun.2022.12.019

Cited by 10 publications

(4 citation statements)

References 134 publications

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“…ABO blood group antigens are in the membranes of erythrocytes and endothelial cells of tissues. Despite the tolerance shown by the immune system of newborns with transplants incompatible with the ABO system, in adults, ABH antibodies bind to the endothelium of the graft with activation of the complement leading to injury and necrosis of the allograft in the process of hyperacute rejection [3]. Due to the limited number of available grafts, attempts for transplants incompatible with the ABO system have been made.…”

Section: Abo and Hla Compatibilitymentioning

confidence: 99%

“…In the first class, the proteins HLA-A, HLA-C, and HLA-B are found in all cells and recognized by CD8+, and in the second class, the proteins HLA-DQ and HLA-DP are located in antigen-presenting cells and recognized by CD4+ T-helper cells. Risk factors for the production of antibodies against the above are pregnancy, previous transplantation, and the use of circulatory support devices [3]. Due to the lack of grafts, for HTx, in contrast to other organs, compatibility testing is not performed in many centers.…”

Section: Abo and Hla Compatibilitymentioning

confidence: 99%

“…These changes were necessitated by the increase in the number of candidate recipients and the increase in the use of mechanical circulatory support devices (MCSD). The 3-tiered system (1A,1B,C) was modified to a 6-tiered system (1)(2)(3)(4)(5)(6). Category 1A of the old system, which included patients who could not be discharged from the hospital, was divided into three categories.…”

Section: Allocation System-graft Distributionmentioning

confidence: 99%

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Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

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Section: Abo and Hla Compatibilitymentioning

confidence: 99%

Section: Abo and Hla Compatibilitymentioning

confidence: 99%

Section: Allocation System-graft Distributionmentioning

confidence: 99%

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Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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“…Viruses 2024, 16, 17 2 of 12 Currently, there are many evolving methods assessing the probability of graft injury [19]. Donor-specific antibodies are connected with antibody-mediated rejection, future graft failure, risk of vasculopathy, and future risk of death and retransplantation among recipients [20].…”

Section: Introductionmentioning

confidence: 99%

Torque Teno Virus (TTV)—A Potential Marker of Immunocompetence in Solid Organ Recipients

Kuczaj,

Przybyłowski,

Hrapkowicz

2023

Viruses

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Torque Teno Virus (TTV), first discovered in 1997, is a non-pathogenic, highly prevalent virus with a notable presence in the human virome. TTV has garnered attention as a potential indicator of immunocompetence in recipients of solid organ transplants. In this review, we discuss the role of TTV as a potential marker for immunosuppression optimization, prediction of graft rejection, and as an indicator of opportunistic infections. We discuss TTV’s behavior over the course of time after transplantation, TTV’s implications in different immunosuppressive regimens, and potential utility in vaccinations. The review synthetizes findings from various studies depicting its potential clinical utility for future personalized patient care.

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