Utilization of intravenous immunoglobulin to ameliorate alloantibodies in a highly sensitized patient with a cardiac assist device awaiting heart transplantation. Fluorescence-activated cell sorter analysis.
Surgery surrounding the use of mechanical assistance in cardiac transplant candidates often leads to multiple blood/platelet transfusions and subsequent development of alloantibodies. This is a case report of a 50-year-old male patient who had received blood transfusions during coronary bypass grafting 9 years earlier. He presented in acute and chronic heart failure and, despite therapy, became moribund with multisystem organ failure. His ejection fraction was 10%. A Novacor ventricular assist device was implanted on May 19, 1995 (day 0). The patient received 44 U of blood and 20 U of platelets. Although his percent reactive antibodies (PRA) were negative before surgery by fluorescence-activated cell sorter analysis, the PRA 3 days after implantation of the ventricular assist device was 80%; it increased to 100% by day 7. In an attempt to decrease the PRA, intravenous immunoglobulin was given at 3-week intervals. The PRA became negative and the patient received a donor heart that was negative by fluorescence-activated cell sorter cross-match on day 64. On days 69-72, a dramatic increase in alloantibody activity was promptly reversed with additional intravenous immunoglobulin. Currently at posttransplant month 12, the patient shows no humoral, cellular, or vascular evidence of rejection.
McIntyre
J A
JA
Department of Transplantation, Methodist Hospital, Indianapolis, Indiana 46202, USA.
Higgins
N
N
Britton
R
R
Faucett
S
S
Johnson
S
S
Beckman
D
D
Hormuth
D
D
Fehrenbacher
J
J
Halbrook
H
H
D001803:Blood Transfusion; D015536:Down-Regulation / Q000187:drug effects; D005434:Flow Cytometry; D016027:Heart Transplantation / Q000276:immunology*; D006353:Heart-Assist Devices; D006801:Humans; D007114:Immunization; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007518:Isoantibodies / Q000096:biosynthesis* / Q000097:blood*; D008297:Male; D008875:Middle Aged
D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies