PMID- 18765198
OWN - NLM
STAT- MEDLINE
DCOM- 20090213
LR  - 20220317
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 27
IP  - 9
DP  - 2008 Sep
TI  - Peri-operative alemtuzumab (Campath-1H) and plasmapheresis for high-PRA positive 
      lymphocyte crossmatch heart transplant: a strategy to shorten left ventricular 
      assist device support.
PG  - 1036-9
LID - 10.1016/j.healun.2008.06.004 [doi]
AB  - Patients on a left ventricular assist device (LVAD) often have a high level of 
      panel-reactive antibodies (PRA). Conventional therapy is to await a heart from a 
      negative prospective-crossmatch donor. We transplanted three high-PRA patients 
      with non-crossmatched hearts, using intra- and post-operative plasmapheresis and 
      long-term T-/B-/plasma-cell therapy with alemtuzumab. Three highly sensitized 
      patients (70%, 94% and 96% T-PRA; 63%, 24% and 73% B-PRA) were transplanted after 
      29, 187 and 94 days LVAD support. The first patient (Case 1) had an erroneous 
      prospective negative crossmatch (due to an outside laboratory's use of the wrong 
      patient's serum) with immediate allograft dysfunction. The correct serum showed a 
      strongly positive crossmatch; plasmapheresis followed by alemtuzumab (20 mg 
      intravenously) shortly after arrival in the ICU resulted in rapid hemodynamic 
      improvement. Encouraged by this success, the next two patients (Cases 2 and 3) 
      underwent LVAD explant and heart transplant with the next available 
      ABO-identical, non-crossmatched donors, using plasmapheresis on bypass 
      immediately before heart implant and alemtuzumab 20 mg intravenously upon ICU 
      arrival, with uneventful courses. All three patients had positive retrospective 
      T- and B-cell crossmatches. Maintenance immunosuppression consisted of 
      cyclosporine and routine prednisone taper, with plasmapheresis as needed (Patient 
      1, x10; Patient 2, x5) based on diastolic dysfunction. Mycophenolate mofetil was 
      started as a third agent several months post-transplant. Patients are presently 
      New York Heart Association (NYHA) Class I at 26, 16 and 13 months 
      post-transplant. In this small series with follow-up, immediate antibody removal 
      with plasmapheresis, combined with alemtuzumab, a long-acting antibody to CD52 
      (expressed on T, B and some plasma cells), appears effective in allowing 
      transplantation in sensitized, positive crossmatch recipients. Expanded use of 
      this strategy could shorten LVAD support in many sensitized patients.
FAU - Lick, Scott D
AU  - Lick SD
AD  - Department of Surgery, University of Texas Medical Branch, Galveston, Texas 
      77555, USA. slick@utmb.edu
FAU - Vaidya, Smita
AU  - Vaidya S
FAU - Kollar, Andras C
AU  - Kollar AC
FAU - Boor, Paul J
AU  - Boor PJ
FAU - Vertrees, Roger A
AU  - Vertrees RA
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20080726
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Antibodies)
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Antibodies, Neoplasm)
RN  - 3A189DH42V (Alemtuzumab)
SB  - IM
MH  - Adult
MH  - Alemtuzumab
MH  - Antibodies/blood
MH  - Antibodies, Monoclonal/administration & dosage/*therapeutic use
MH  - Antibodies, Monoclonal, Humanized
MH  - Antibodies, Neoplasm/administration & dosage/*therapeutic use
MH  - Cardiomyopathies/*surgery
MH  - Female
MH  - Heart Transplantation/*immunology
MH  - *Heart-Assist Devices
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Perioperative Care
MH  - Plasmapheresis/*methods
MH  - Treatment Outcome
MH  - Ventricular Function, Left/physiology
MH  - Young Adult
EDAT- 2008/09/04 09:00
MHDA- 2009/02/14 09:00
CRDT- 2008/09/04 09:00
PHST- 2008/03/20 00:00 [received]
PHST- 2008/05/28 00:00 [revised]
PHST- 2008/06/05 00:00 [accepted]
PHST- 2008/09/04 09:00 [pubmed]
PHST- 2009/02/14 09:00 [medline]
PHST- 2008/09/04 09:00 [entrez]
AID - S1053-2498(08)00437-3 [pii]
AID - 10.1016/j.healun.2008.06.004 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2008 Sep;27(9):1036-9. doi: 
      10.1016/j.healun.2008.06.004. Epub 2008 Jul 26.