title: In praise of ventricular assist devices-mechanical bridge to virtual crossmatch for the sensitized patient.
abstract: Human leukocyte antigen (HLA) sensitization is a common problem in patients being assessed for organ transplantation. Two overarching principles that must be adhered to when evaluating approaches to sensitized patients are: (1) ensuring equitable access for potential recipients to transplantable organs; and (2) maintaining optimal long-term patient and graft outcomes post-transplant. Approaches increasingly used to manage sensitized heart transplant candidates are crossmatching (virtual [VXM], based on comparison of donor HLA to recipient antibody specificities, or prospective real-time [XM]) to avoid donor-specific antibodies, or desensitization to reduce the amount of antibodies that are present. We propose that the best strategy for management of highly sensitized patients awaiting heart transplantation is combining mechanical circulatory support as a bridge to a (-) VXM or XM together with adoption of a national prioritized sharing algorithm for highly sensitized patients.
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
authors.forename: Kathryn
authors.initials: K
authors.lastname: Tinckam
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Lori J
authors.initials: LJ
authors.lastname: West
mesh_terms: D000906:Antibodies / Q000097:blood; D006680:HLA Antigens / Q000276:immunology; D006331:Heart Diseases / Q000097:blood / Q000628:therapy*; D016027:Heart Transplantation / Q000276:immunology*; D006353:Heart-Assist Devices; D006650:Histocompatibility Testing; D006801:Humans; D007114:Immunization; D013997:Time Factors
chemical_list: D000906:Antibodies; D006680:HLA Antigens