Management of the sensitized cardiac recipient: the use of plasmapheresis and intravenous immunoglobulin

Clin Transplant. Jul-Aug 2006;20(4):476-84. doi: 10.1111/j.1399-0012.2006.00509.x.

Abstract

Previously, we reported that the combination of plasmapheresis (PP) and intravenous immunoglobulin (IVIg) allow sensitized patients to undergo orthotopic heart transplantation (OHT), even across a positive crossmatch. In the current study, the effect of that combination, PP+IVIg, on survival of a larger group of such recipients is investigated. The latter group (I) consisted of 35 sensitized patients who received PP+IVIG together with standard immunosuppressive drugs. Rejection was seen in 11 patients, findings strongly suggestive of a vascular (humoral) being identified in five of those cases. Four deaths occurred, two of them in the immediate post-operative period, one after almost six months, and one after almost two yr post-OHT. Follow-up range 4.5 months to 7.8 yr post-OHT (average=1.1 yr). Patient survival was analyzed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given standard immunosuppressive drugs only (N=276) showed enhanced survival of group I (p=0.0414 by log-rank test). We conclude that the combination of PP and IVIG (i) is associated with declines in T- and B-percent-reactive antibody and in crossmatch positivity, and (ii) is very useful in the management of the sensitized cardiac patient undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch.

MeSH terms

  • Biopsy
  • Graft Rejection / epidemiology
  • Heart Transplantation / immunology
  • Heart Transplantation / mortality
  • Heart Transplantation / pathology
  • Heart Transplantation / physiology*
  • Histocompatibility Testing
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunosuppressive Agents / therapeutic use
  • Isoantibodies / blood
  • Plasmapheresis*
  • Survival Analysis

Substances

  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents
  • Isoantibodies