title: Management of the sensitized cardiac recipient: the use of plasmapheresis and intravenous immunoglobulin.
abstract: Previously, we reported that the combination of plasmapheresis (PP) and intravenous immunoglobulin (IVIg) allow sensitized patients to undergo orthotopic heart transplantation (OHT), even across a positive crossmatch. In the current study, the effect of that combination, PP+IVIg, on survival of a larger group of such recipients is investigated. The latter group (I) consisted of 35 sensitized patients who received PP+IVIG together with standard immunosuppressive drugs. Rejection was seen in 11 patients, findings strongly suggestive of a vascular (humoral) being identified in five of those cases. Four deaths occurred, two of them in the immediate post-operative period, one after almost six months, and one after almost two yr post-OHT. Follow-up range 4.5 months to 7.8 yr post-OHT (average=1.1 yr). Patient survival was analyzed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given standard immunosuppressive drugs only (N=276) showed enhanced survival of group I (p=0.0414 by log-rank test). We conclude that the combination of PP and IVIG (i) is associated with declines in T- and B-percent-reactive antibody and in crossmatch positivity, and (ii) is very useful in the management of the sensitized cardiac patient undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch.
authors.affiliation: Department of Cardiology, Temple University Hospital and School of Medicine, Philadelphia, PA 19140, USA. leechsh@tuhs.temple.edu
authors.forename: S H
authors.initials: SH
authors.lastname: Leech
authors.forename: M
authors.initials: M
authors.lastname: Lopez-Cepero
authors.forename: W M
authors.initials: WM
authors.lastname: LeFor
authors.forename: L
authors.initials: L
authors.lastname: DiChiara
authors.forename: M
authors.initials: M
authors.lastname: Weston
authors.forename: S
authors.initials: S
authors.lastname: Furukawa
authors.forename: M
authors.initials: M
authors.lastname: Macha
authors.forename: A
authors.initials: A
authors.lastname: Singhal
authors.forename: J W
authors.initials: JW
authors.lastname: Wald
authors.forename: L A
authors.initials: LA
authors.lastname: Nikolaidis
authors.forename: J B
authors.initials: JB
authors.lastname: McClurken
authors.forename: A A
authors.initials: AA
authors.lastname: Bove
mesh_terms: D001706:Biopsy; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D010956:Plasmapheresis; D016019:Survival Analysis
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies