Immunosuppression in the sensitized heart transplant recipient.
OBJECTIVE
The proportion of heart transplant candidates who are allosensitized has increased over time. Advances in tissue typing and immunosuppression have improved the rate of successful transplant in this challenging population. Recently published data regarding contemporary approaches to desensitization prior to and immunosuppression following transplant are summarized.


RESULTS
Continued progress in measurement and characterization of antibodies and strategies to abrogate antibody production both prior to and following heart transplant have been encouraging. Updates on the role of non-human leukocyte antigen antibodies and the impact of mechanical circulatory support on allosensitization are provided. Data on current desensitization strategies, including the increasing use of monoclonal antibodies, are provided and the potential role of complement inhibitors will be reviewed. Increasing experience with potent novel agents is likely to provide the opportunity to improve transplant outcomes for highly sensitized patients.


CONCLUSIONS
Although allosensitized heart transplant candidates remain a management challenge, excellent outcomes can be achieved with contemporary approaches. Advances in the understanding of B-cell biology are anticipated to further broaden options and improve outcomes.
Eckman
Peter M
PM
Section of Heart Failure and Transplant, Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA. eckmanp@umn.edu
D001243:Assisted Circulation / Q000009:adverse effects; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D016027:Heart Transplantation / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood*; D007519:Isoantigens / Q000276:immunology*; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D007518:Isoantibodies; D007519:Isoantigens