Heart transplantation across antibodies against human leukocyte antigen and ABO-post-transplant follow-up of donor reactive antibodies

Xenotransplantation
Dragan BucinLars O Lindberg

Abstract

We have successfully performed heart transplantation despite the most unfavourable risk factors for graft and patient survival: the presence of a high level of antibodies (Abs) against the donor's human leukocyte antigens (HLA) class I/II and blood group A1 antigens. The present study concerns post-transplant follow-up and characterization of donor reactive antibodies (DRA). Pre-transplant treatment consisted of mycophenolate mofetil (MMF), prednisolone, tacrolimus, intravenous immunoglobulin (IVIG), rituximab, protein-A immunoadsorption (PAIA) and per-operative plasma exchange. A standard triple-drug immunosuppressive protocol was used post-operatively. Abs were analyzed by the complement dependent cytotoxicity (CDC) test against donor and panel B/T cells and by flow cytometry (FlowPRA tests detecting isolated HLA class I/II antigens). Abs against the donor's erythrocytes were analyzed using a standard direct agglutination test for immunoglobulin M (IgM) Abs and a Bio-Rad AHG gel card test detecting IgG Abs and C3d. Pre-transplant treatment reduced Ab titers against the donor's lymphocytes from 128 to 16 and against the donor's blood group A1 antigen from 256 to 0. The patient was emergently transplanted with a heart from a bl...Continue Reading

References

Aug 19, 1999·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·B A PisaniJ A Robinson
Jun 7, 2003·Transplantation·Aliki G Iniotaki-TheodorakiCatherine G Stavropoulos-Giokas
Jul 16, 2003·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Walter D ParkMark D Stegall
Jun 19, 2004·Transplant Immunology·Nancy L ReinsmoenAdriana Zeevi
Jan 31, 2006·Transplant International : Official Journal of the European Society for Organ Transplantation·Dragan BucinGisela Otto

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Citations

Aug 13, 2011·Current Opinion in Organ Transplantation·Lori J West
Nov 21, 2007·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·S L RocheA Hasan
Jan 12, 2012·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·J ConwayA I Dipchand
Apr 17, 2012·Pediatric Transplantation·Clifford Chin

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