Report From a Consensus Conference on the Sensitized Patient Awaiting Heart Transplantation

Kobashigawa, Jon A.; Mehra, Mandeep R.; West, Lori J.; Kerman, Ronald H.; George, James F.; Rose, Marlene L.; Zeevi, Adriana; Reinsmoen, Nancy L.; Patel, Jignesh; Reed, Elaine F.

doi:10.1016/j.healun.2008.12.017

Cited by 168 publications

(106 citation statements)

References 62 publications

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“…These transmittals are influenced by antibody specificity and concentration. 37 The high concentration of class I anti-HLA antibodies transmits inflammatory, and proliferative signals promoting chronic or hyperacute rejection. 38,39 Instead, a low concentration of the same antibodies up-regulates expression of antiapoptotic proteins conferring resistance to damage.…”

Section: Introductionmentioning

confidence: 99%

“…45 On the other hand, cell-based assays mimic physiological conditions but are less sensitive and specific, and they can cause false reactivity. 37 Furthermore, the CDC cannot distinguish between class I and II anti-HLA antibodies and requires a large cell panel to provide coverage for detecting both the most common and rare HLA antigens. 13 Complement-dependent cytotoxicity assay detects both IgG and IgM anti-HLA antibodies, both activating and nonactivating the complement.…”

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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Concepts in Histocompatibility During Heart Transplant

Picascia

Grimaldi²,

Zullo³

et al. 2012

Exp Clin Transplant

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“…Unfortunately, antibody levels often rebound shortly after treatment. 47 Alternatively, immunoadsorption passes serum over a column containing beads bound to a factor that binds antibodies. These modalities are often used in combination with other immunomodulative therapies, particularly IVIG.…”

Section: Castleberry Et Al Highly Sensitized Pediatric Heart Transplamentioning

confidence: 99%

Transplantation in the Highly Sensitized Pediatric Patient

2014

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“…Immunocompatibility testing including ABO blood group typing, human leukocyte antigen and antibody screening should be completed. Panel-reactive antibody (PRA) test, which can identify the presence of circulating anti-human leukocyte antigen (HLA), and should be performed preferably by flow cytometry [53]. In France, single center data reported that actuarial survival rates were 75%, 58%, and 42% at 5, 10, and 15 years, respectively [54].…”

Section: Heart Transplantation and Heart Failurementioning

confidence: 99%