How to deal with presensitized candidates for heart transplantation?

Arvind Bhimaraj, David O. Taylor

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

Purpose of Review: With increasing utilization of assist devices and adoption of calculated panel-reactive antibody (cPRA), the number of presensitized patients being listed for heart transplantation is increasing. An effort to standardize identification and management of such patients is paramount and recently initiated in the heart transplant community. The current review describes the basic concepts of presensitization and details the most relevant work including the latest advancements in this area. Recent Findings: More sensitive techniques in identifying presensitized patients have posed challenges in understanding the clinical relevance and implications of such testing. cPRA has been shown to benefit presensitized heart transplant patients. De-sensitization strategies have never been studied in a large clinical trial setting but a combination of plasmapheresis and intravenous immunoglobulin has been shown to be beneficial in small studies. Long-term positive outcomes of de-sensitization have been recently reported. Newer agents like alemtuzumab, bortezomib and complement inhibitors have been reported in case reports and series with promising results as de-sensitization strategy. Summary: Data specific to strategies and therapies in heart transplantation are sparse and most knowledge stems from other organ transplantation. Consensus efforts to standardize care and also advance research in this area were initiated recently with hope for improving care for these patients.

Original languageEnglish (US)
Pages (from-to)529-535
Number of pages7
JournalCurrent opinion in organ transplantation
Volume16
Issue number5
DOIs
StatePublished - Oct 1 2011

Keywords

  • Clinical management
  • heart transplantation
  • presensitization

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation

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