title: [Preparation of highly HLA-sensitized patient for heart transplantation: first documented case in Croatia].
abstract: The presence of human leukocyte antigen (HLA) poses a significant therapeutic challenge in solid organ transplantation. Sensitized patients (panel reactive antibody, PRA > 10%) receiving a heart transplant are at an increased risk of developing several clinical syndromes that influence short-term, and possibly also long-term patient survival. We present a case of immune system modulation in a highly sensitized patient awaiting heart transplantation. To our knowledge, this is the first case of desensitization therapy in solid organ transplantation done in Croatia. The patient with decompensated primary dilated cardiomyopathy received left ventricular assist device as a bridge to heart transplantation. Pre-transplantation evaluation revealed the presence of fungal pneumonia and high sensitization to HLA antibodies (PRA 97%). Desensitization protocol consisted of mycophenolate mofetil, tacrolimus, intravenous immune globulin and preoperative plasmapheresis along with previously initiated antifungal therapy. We withheld the application of rituximab until after resolution of pneumonia, but our protocol lowered PRA to 6% even without it. Unfortunately, during the next several weeks, a suitable donor was not found and our patient died form multiorgan failure. Avoidance of allosensitization by early referral to transplantation center, early transplantation, and avoidance of transfusions are very important when treating a potential transplant recipient. In this way, waiting time to transplantation, development of posttransplantation complications and mortality are reduced.
authors.affiliation: Klinicki bolnicki centar Zagreb, Zavod za dijalizu, Zagreb, Hrvatska.
authors.forename: Bruna Brunetta
authors.initials: BB
authors.lastname: Gavranić
authors.forename: Nikolina
authors.initials: N
authors.lastname: Basić-Jukić
authors.forename: Iva
authors.initials: I
authors.lastname: Ratković-Gusić
authors.forename: Natalija
authors.initials: N
authors.lastname: Martinez
authors.forename: Visnja
authors.initials: V
authors.lastname: Ivancan
authors.forename: Petar
authors.initials: P
authors.lastname: Kes
mesh_terms: D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007518:Isoantibodies / Q000032:analysis*; D008875:Middle Aged; D010956:Plasmapheresis; D011300:Preoperative Care
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies