Outcomes of pre- heart transplantation desensitization in a series of highly sensitized patients bridged with left ventricular assist devices.
J Heart Lung Transplant
; 40(10): 1107-1111, 2021 10.
Article
en En
| MEDLINE
| ID: mdl-34281777
ABSTRACT
Desensitization therapy for heart transplantation (HT) candidates can shorten transplant wait times and broaden the donor pool. Specific evidence-based recommendations on both protocols and indications are lacking. We retrospectively assessed left ventricular assist devices-bridged candidates who received pre-HT desensitization therapy. The therapeutic protocol consisted of intravenous immunoglobulin and rituximab followed by bortezomib and plasmapheresis if an insufficient response was achieved. Desensitization was attempted in 10 patients; only 7 tolerated therapy and underwent transplant. For those patients, median decrease in unacceptable calculated panel reactive antibody was 11%; there was no significant decrease for 3 patients. Post-desensitization adverse events were observed in all patients which included coagulopathy, bone marrow suppression, and infection. Median time to first infection was 16 days. One patient had clinically significant rejection and 3 patients had uptrending donor-specific antibodies. Decisions to proceed with desensitization should be individualized understanding potential risks and benefits.
Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Corazón Auxiliar
/
Desensibilización Inmunológica
/
Trasplante de Corazón
/
Rechazo de Injerto
/
Isoanticuerpos
Tipo de estudio:
Guideline
/
Prognostic_studies
Idioma:
En
Revista:
J Heart Lung Transplant
Asunto de la revista:
CARDIOLOGIA
/
TRANSPLANTE
Año:
2021
Tipo del documento:
Article