Understanding the Sensitized Patient

Vision Improvement in Retinal Degeneration Patients by Implantation of Retina Together with Retinal Pigment Epithelium

“…Frequently, if patients are re-exposed to an antigen they have been sensitized to previously, their titer of antibody will increase and will persist. 32 We did not see that kind of response in any of our patients that demonstrated previous sensitization. With the exception of one patient (Patient 2) whose anti-HLA specificity could not be defined, there was no de novo donor-specific HLA antibody detected in any of our patients.…”

“…If regulatory T cells are developing in response to retinal implants, they are not inhibiting memory B-cell antibody production as all antibody specificities, donor directed and non-donor specific, persisted in all sensitized patients studied here. 32 In eight of 10 cases, the transplanted RPE cells lost their pigmentation at three to six months postoperatively, which could indicate graft rejection. However, the phenomenon of pigment loss has also been observed in co-grafts to Royal College of Surgeons (RCS) rats where the unpigmented donor RPE cells could nevertheless be identified histologically.…”

Present Status and Future Perspectives of Heart Transplantation

“…Kerman described a method of understanding the sensitized patient to determine whether these antibodies may increase the risk of post-transplant adverse outcomes, as is the case with anti-HLA immunoglobulins. 23 Anti-HLA antibodies are directed to donor major histocompatibility complex (MHC) classes I and II HLA antigens that are expressed on allograft endothelial cells. The risk of early graft failure after transplant is higher in the presence of a TOYODA Y et al…”

Treatment of Chronic Heart Failure

“…This changing patient population brings new challenges to the transplant physicians. Among them, the risk of having preformed antibodies directed against the donor heart (sensitized patients) is particularly challenging as it may increase the risk of rejection and allograft vasculopathy [7,81]. Once considered an absolute contraindication to transplantation, older recipient age is now seen as a relative contraindication [82].…”

“…Patients who require MCS are at increased risk for rejection, infection, stroke, and bleeding. The need for transfusions and possibly the mechanical devices themselves increase the risk of presensitization [7,81]. Based on the International Society for Heart & Lung Transplantation (ISHLT) database, survival at 1 and 5 years is reduced in patients requiring MCS but still higher than 80 and 70%, respectively [7].…”