Immunosuppression in the sensitized heart transplant recipient

Eckman, Peter

doi:10.1097/mot.0b013e32833de9b2

Cited by 10 publications

(13 citation statements)

References 70 publications

(60 reference statements)

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“…These results are significant, because earlier studies showed overall poor outcomes due to increased risk for graft dysfunction, acute cellular rejection and AMR and CAV. 1,2 Many pediatric heart transplant programs still require a negative crossmatch before accepting a donor organ in highly sensitized recipients. Feingold et al 4 showed that there were significantly longer waiting times for patients with PRA 420% who required a negative crossmatch.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes in highly sensitized pediatric heart transplant patients using current management strategies

Asante‐Korang¹,

Amankwah

Lopez‐Cepero

et al. 2015

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

“…1,2 In 2004, Jacobs et al 3 described our outcomes data in presensitized patients. One-and 5-year survival rates were sobering at 60% and 45%, respectively.…”

mentioning

confidence: 96%

Outcomes in highly sensitized pediatric heart transplant patients using current management strategies

Asante‐Korang¹,

Amankwah

Lopez‐Cepero

et al. 2015

The Journal of Heart and Lung Transplantation

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“…75 Moreover, all conventional immunosuppressive therapies and desensitization regimens, including rituximab, have no effect on depletion of plasma cells. 14,49 Probably, the immunosuppressive treatments that fail to inhibit the mature plasma cells have little effect on reducing antibody production.…”

Section: Novel Approaches On Sensitized Patientsmentioning

confidence: 99%

“…11,64 Currently used protocols take different approaches: Removal of anti-HLA antibodies from circulation and drug administration to reduce their production also in combination with other agents, before, perioperatively, or immediately after transplant. 14,49 For several years, AMR therapy and desensitization regimens have been based on plasmapheresis, intravenous immunoglobulin (IVIG), antilymphocyte antibody preparations, and, more recently, on a B-cell-specific monoclonal antibody (rituximab) and a proteasome inhibitor (bortezomib).…”

Section: Virtual Crossmatchmentioning

confidence: 99%

“…13 Although several treatments (such as combination of plasmapheresis with immunomodulators) are used to decrease allosensitization, new strategies are required to prevent or reduce anti-HLA antibodies from developing in patients on waiting list for a heart transplant. 14,15 controversial issues in human leukocyte antigen matching in a heart transplant The importance of HLA matching to improve outcome in kidney and bone marrow transplant has been widely accepted, whereas it is still debated in heart transplants. [16][17][18] There is a paucity of research on the clinical relevance of HLA matching in heart transplanting, because the HLA is not a selection criterion of the recipient's choice.…”

Section: Introductionmentioning

confidence: 99%

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Current Concepts in Histocompatibility During Heart Transplant

Picascia

Grimaldi²,

Zullo³

et al. 2012

Exp Clin Transplant

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Sensitized candidates for heart transplant usually end up on a long waiting list and have an increased risk of rejection, graft loss, and incidence of cardiac allograft vasculopathy. An increasing number of studies have demonstrated the negative effect of preformed and posttransplant antibodies on graft survival. Thus, in sensitized patients, the combination of new, appropriate, desensitization protocols, and monitoring of posttransplant development of donor-specific antibodies may improve short-term and long-term outcomes. Introduction of more-sensitive and more-specific techniques for antibody detection provides a valid tool for assessing the degree of pretransplant HLA histocompatibility, and, therefore, predicting the results of crossmatch in sensitized patients, which are difficult to transplant. Currently, there are no accurate and standard methods to determine the functional characteristics of antibodies detected by solid-phase assay and, therefore, to predict their clinical relevance. Therefore, the future of heart transplantation requires a better understanding of tissue typing techniques and the effect of anti-HLA antibodies on clinical outcome to prevent discrimination against sensitized patients at the time of organ allocation.

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Human Leukocyte Antigens and Alloimmunization in Heart Transplantation: An Open Debate

Picascia¹,

Grimaldi²,

Casamassimi

et al. 2014

J. of Cardiovasc. Trans. Res.

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Considerable advances in heart transplantation outcome have been achieved through the improvement of donor-recipient selection, better organ preservation, lower rates of perioperative mortality and the use of innovative immunosuppressive protocols. Nevertheless, long-term survival is still influenced by late complications. We support the introduction of HLA matching as an additional criterion in the heart allocation. Indeed, allosensitization is an important factor affecting heart transplantation and the presence of anti-HLA antibodies causes an increased risk of antibody-mediated rejection and graft failure. On the other hand, the rate of heart-immunized patients awaiting transplantation is steadily increasing due to the limited availability of organs and an increased use of ventricular assist devices. Significant benefits may result from virtual crossmatch approach that prevents transplantation in the presence of unacceptable donor antigens. A combination of both virtual crossmatch and a tailored desensitization therapy could be a good compromise for a favorable outcome in highly sensitized patients. Here, we discuss the unresolved issue on the clinical immunology of heart transplantation.

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Immunosuppression in the sensitized heart transplant recipient

Abstract: Although allosensitized heart transplant candidates remain a management challenge, excellent outcomes can be achieved with contemporary approaches. Advances in the understanding of B-cell biology are anticipated to further broaden options and improve outcomes.

Cited by 10 publications

References 70 publications

Outcomes in highly sensitized pediatric heart transplant patients using current management strategies

Outcomes in highly sensitized pediatric heart transplant patients using current management strategies

Current Concepts in Histocompatibility During Heart Transplant

Human Leukocyte Antigens and Alloimmunization in Heart Transplantation: An Open Debate

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