The long-term outcome of treated sensitized patients who undergo heart transplantation.
BACKGROUND
Sensitized patients prior to heart transplantation are reportedly at risk for hyperacute rejection and for poor outcome after heart transplantation. It is not known whether the reduction of circulating antibodies pre-transplant alters post-transplant outcome.


RESULTS
Between July 1993 and July 2003, we reviewed 523 heart transplant patients of which 95 had pre-transplant panel reactive antibody (PRAs) >10%; 21/95 were treated pre-transplant for circulating antibodies. These 21 patients had PRAs > 10% (majority 50-100%) and were treated with combination therapy including plasmapheresis, intravenous gamma globulin and rituximab to reduce antibody counts. The 74 untreated patients with PRAs > 10% (untreated sensitized group) and those patients with PRAs < 10% (control group) were used for comparison. Routine post-transplant immunosuppression included triple-drug therapy. After desensitization therapy, circulating antibody levels pre-transplant decreased from a mean of 70.5 to 30.2%, which resulted in a negative prospective donor-specific crossmatch and successful heart transplantation. Compared to the untreated sensitized group and the control group, the treated sensitized group had similar five-yr survival (81.1% and 75.7% vs. 71.4%, respectively, p = 0.523) and freedom from cardiac allograft vasculopathy (74.3% and 72.7% vs. 76.2%, respectively, p = 0.850).


CONCLUSIONS
Treatment of sensitized patients pre-transplant appears to result in acceptable long-term outcome after heart transplantation.
Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA. kobashigawaj@cshs.org
Jon A
JA
Kobashigawa
Jignesh K
JK
Patel
Michelle M
MM
Kittleson
Matt A
MA
Kawano
Krista K
KK
Kiyosaki
Stephanie N
SN
Davis
Jaime D
JD
Moriguchi
Elaine F
EF
Reed
Abbas A
AA
Ardehali
D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D001323:Autoantibodies / Q000097:blood*; D001788:Blood Grouping and Crossmatching; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011300:Preoperative Care; D011446:Prospective Studies; D000069283:Rituximab; D015996:Survival Rate; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab; D003520:Cyclophosphamide