title: Management of the sensitized adult heart transplant candidate.
abstract: Heart transplant recipients sensitized to human leukocyte antigens comprise a challenging subgroup of patients. Sensitization has been associated with a variety of effects that determine short-term and long-term outcomes. These include a higher rate of acute rejection and graft loss, and a heightened risk for developing cardiac allograft vasculopathy. Because of improvements in both tissue typing and immunomodulatory therapies coupled with the growing population receiving mechanical circulatory support/LVAD, the percent of sensitized patients listed for heart transplantation has increased, inflicting a greater burden to the already scarce donor pool. Despite these potentially adverse developments, pre-transplant immunologic management has resulted in decreased waiting times and outcomes that were not possible over 10 yr ago. The following review will focus on the contemporary management of the sensitized heart transplant candidate and highlight therapies that have allowed the successful transplantation of this growing and challenging patient population, including several approaches in development.
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA. eckmanp@umn.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
authors.forename: Mazen
authors.initials: M
authors.lastname: Hanna
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
mesh_terms: D000328:Adult; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans
chemical_list: D006680:HLA Antigens