Terminal Complement Inhibition for Highly Sensitized Patients Undergoing Heart Transplantation - Doable?

Patel, J.; Dilibero, Deanna; Kittleson, M.; Sana, S.; Liou, Frank W.; Chang, D.; Hage, Ali; Czer, L.; Trento, Alfredo; Reinsmoen, N.; Kobashigawa, J.A.

doi:10.1016/j.healun.2015.01.073

Cited by 13 publications

(6 citation statements)

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“…12 There is an ongoing trial incorporating the use of eculizumab in adult recipients who are highly sensitised as preventive therapy for antibodymediated rejection early post-transplant. 13 Whether the outcome of the 14 patients in our study could have been improved with earlier initiation or with selection of less compromised patients for treatment, either to stabilisation or to remission with recovery of graft function or rejection activity to allow re-transplantation cannot be determined. Nevertheless, given the poor prognosis of antibody-mediated rejection, one has to wonder if the patients who survived without re-transplant would have done so if they did not receive eculizumab.…”

Section: Discussionmentioning

confidence: 94%

“…For those who stayed on eculizumab longer (5), their duration ranged from 6 to 12 months. Other therapies for antibody-mediated rejection were employed in addition to eculizumab, including steroid (n = 12), anti-thymocyte globulin (9), bortezomib (10), rituximab (12), intravenous immunoglobulin (13), and plasmapheresis (13). The most common combinations were all of the above without anti-thymocyte globulin (6) or all of the above (5).…”

Section: Administration Of Eculizumab and Other Treatments Of Antibodmentioning

confidence: 99%

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Use of the terminal complement inhibitor eculizumab in paediatric heart transplant recipients

et al. 2019

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Antibody-mediated rejection is a major clinical challenge that limits graft survival. Various modalities of treatment have been reported in small studies in paediatric heart recipients. A novel approach is to use complement-inhibiting agents, such as eculizumab, which inhibits cleavage of C5 to C5a thereby limiting the formation of membrane attack complex and terminal complement-mediated injury of tissue-bound antibodies. This medical modality of treatment has theoretical advantages but the collective experience in its use in the solid organ transplant community remains small. We add to this experience by combining 14 cases from 6 paediatric heart centres in this descriptive study.

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Section: Discussionmentioning

confidence: 94%

Section: Administration Of Eculizumab and Other Treatments Of Antibodmentioning

confidence: 99%

Use of the terminal complement inhibitor eculizumab in paediatric heart transplant recipients

et al. 2019

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“…Sensitized patients who were desensitized also had rates of 5-year survival and CAV that were comparable with nonsensitized patients [24]. More recently, a pilot study of highly sensitized patients with cPRA more than 90% treated with the terminal complement inhibitor eculizumab, showed satisfactory 1-year survival of 88.9% [25]. There was one intraoperative death due to purulent mediastinitis but otherwise no treated infections.…”

Section: Desensitizing Highly Sensitized Patientsmentioning

confidence: 77%

Does the Canadian allocation system for highly sensitized patients work?

Aleksova

Ross

2019

Current Opinion in Organ Transplantation

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Purpose of reviewThe number of sensitized heart transplant candidates is rising. Highly sensitized patients are disadvantaged because they encounter longer waiting times to heart transplant. Strategies to reduce their waiting times include waitlist prioritization and desensitization therapies. The purpose of this review is to describe the listing category for highly sensitized patients in the Canadian allocation system, examine the advantages and limitations of this strategy and provide an approach to the management of the highly sensitized patient awaiting heart transplant. Recent findingsAnalysis of data from the United Network of Organ Sharing shows that the incidence of death or removal from the waitlist in patients listed for heart transplant increases as the calculated panel reactive antibody (cPRA) increases and is independent of medical urgency. In the Canadian allocation system, patients with cPRA more than 80% have a similar incidence of death on the waitlist as less sensitized patients, suggesting they survive to be transplanted. Furthermore, prioritizing and transplanting highly sensitized patients has been associated with acceptable post-transplant outcomes.

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“…There is limited experience with the complement inhibitor eculizumab. 84 Existing data on the efficacy of desensitization are primarily extrapolated from renal literature. Strategies involving IVIG and rituximab have increased transplantation rates, reduced wait list time, and reported graft outcomes similar to those of nonsensitized patients.…”

Section: Highly Sensitizedmentioning

confidence: 99%

Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care

Chih

McDonald

Dipchand

et al. 2020

Canadian Journal of Cardiology

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Significant practice-changing developments have occurred in the care of heart transplantation candidates and recipients over the past decade. This Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement provides evidence-based, expert panel recommendations with values and preferences, and practical tips on: (1) patient selection criteria; (2) selected patient populations; and (3) post transplantation surveillance. The recom-R ESUM E Les pratiques relatives aux soins prodigu es aux candidats à une transplantation cardiaque et aux receveurs d'un nouveau coeur ont beaucoup evolu e depuis dix ans. Le pr esent enonc e de position conjoint de la Soci et e canadienne de cardiologie et du Canadian Cardiac Transplant Network fait etat des recommandations d'un groupe d'experts fond ees sur des donn ees probantes, et comprend des valeurs et des pr ef erences ainsi que des conseils pratiques concernant

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Terminal Complement Inhibition for Highly Sensitized Patients Undergoing Heart Transplantation - Doable?

Cited by 13 publications

References 0 publications

Use of the terminal complement inhibitor eculizumab in paediatric heart transplant recipients

Use of the terminal complement inhibitor eculizumab in paediatric heart transplant recipients

Does the Canadian allocation system for highly sensitized patients work?

Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care

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