The use of the calculated panel-reactive antibody and virtual crossmatch in heart transplantation.
OBJECTIVE
Alloantibodies to human leukocyte antigens (HLAs) in patients awaiting heart transplantation are associated with prolonged wait time to transplant, increased risk of posttransplant rejection and cardiac allograft vasculopathy, and decreased survival. Solid-phase assays to determine antibody presence have allowed for the development of a calculated panel-reactive antibody to denote unacceptable antigens. The virtual crossmatch allows for the comparison of recipient HLA antibodies to prospective donor HLA antigens to safely match a patient to an appropriate donor without a prospective crossmatch.


RESULTS
Expansion of the donor pool and decreased waiting time for heart transplant may be impacted by further assessment of the functional status of alloantibodies and novel means for desensitization. Sensitized patients who receive left ventricular assist device (LVAD) as a bridge to cardiac transplant appear to have similar postoperative 1-year outcomes compared with nonsensitized patients.


CONCLUSIONS
Antibody sensitization poses an additional hurdle to patients awaiting heart transplantation. Functional antibody assessment, placement of a LVAD as bridge to cardiac transplant, and novel means of desensitization may impact a sensitized patient's ability to safely undergo heart transplantation.
Cedars-Sinai Heart Institute, Los Angeles, California 90048, USA.
David
D
Chang
Jon
J
Kobashigawa
D000906:Antibodies / Q000276:immunology; D015922:Complement C1q / Q000032:analysis; D003888:Desensitization, Immunologic / Q000379:methods; D006680:HLA Antigens / Q000276:immunology*; D006331:Heart Diseases / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*
D000906:Antibodies; D006680:HLA Antigens; D007518:Isoantibodies; D015922:Complement C1q