Desensitization Strategies Pre- and Post-Cardiac Transplantation

Current Treatment Options in Cardiovascular Medicine
Robert M Cole, Jon A Kobashigawa

Abstract

Panel reactive antibody (PRA) testing has become standard in the evaluation of patients prior to cardiac transplant. Sensitizing events such as blood transfusions, which result in the accumulation of pre-transplant antibodies, should be avoided as clinically feasible. Desensitization therapy might be considered in sensitized patients with cPRA > 50 % although distinct cutoff PRA values for initiating therapy pre-transplant are patient and transplant program dependent. Post-cardiac transplant, quantitative antibodies should also be periodically analyzed, at intervals individualized to the patient. Donor-specific antibodies (DSA) after cardiac transplantation have been shown to be associated with worsened survival. It appears that complement fixing DSA confer the greatest risk for antibody-mediated rejection post-transplant. Desensitization strategies aim to reduce the number of clinically important antibodies prior to and after transplant, both by removal of antibodies and cessation of further production. Current desensitization regimens include pharmacologic, procedural, and surgical modalities, and must be individualized to the patient. Currently, most cardiac transplant programs tailor the post-transplant immunosuppressive re...Continue Reading

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Citations

Feb 18, 2017·Current Opinion in Cardiology·David H Chang, Jon A Kobashigawa
Jun 28, 2017·Current Opinion in Organ Transplantation·Kelly H Schlendorf, Ashish S Shah
Apr 6, 2019·Current Opinion in Organ Transplantation·Faith Njue, Sharon Chih
Jun 18, 2019·Clinical Transplantation·Kevin S Shah, Jignesh Patel
May 16, 2019·Current Opinion in Organ Transplantation·Faith Njue, Sharon Chih
Feb 14, 2017·Frontiers in Immunology·Massimo MangiolaAdriana Zeevi
Jun 27, 2019·Current Heart Failure Reports·Kevin S ShahJon A Kobashigawa
Dec 19, 2020·Clinical Transplantation·Gayatri SetiaJon Kobashigawa
Nov 28, 2017·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Joren C Madsen

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