PMID- 20885338
OWN - NLM
STAT- MEDLINE
DCOM- 20110107
LR  - 20220317
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 90
IP  - 11
DP  - 2010 Dec 15
TI  - Desensitization and heart transplantation of a patient with high levels of 
      donor-reactive anti-human leukocyte antigen antibodies.
PG  - 1220-5
LID - 10.1097/TP.0b013e3181fa93c6 [doi]
AB  - BACKGROUND: To prepare a highly immunized recipient for heart transplantation, 
      reduction of high levels of cytotoxic antibodies against human leukocyte antigen 
      (HLA) was deemed essential to prevent antibody-mediated graft failure. METHODS: 
      Antibodies were analyzed by lymphocytotoxic and solid-phase assays. The 
      pretransplant desensitization treatment protocol included daily tacrolimus and 
      mycophenolate mofetil, weekly protein-A immunoadsorption (IA), intravenous 
      immunoglobulin, and daclizumab. Posttransplant treatment consisted of tacrolimus, 
      mycophenolate mofetil, prednisolone, IA, and daclizumab. RESULTS: During 
      pretransplant desensitization, each of the weekly immunoadsorption treatments 
      reduced anti-HLA antibody levels by 50% to 70%, but they returned to the 
      pretreatment level within 1 week as measured by flow cytometry. Cytotoxic 
      antibodies remained reduced. After perioperative immunoadsorption, the 
      donor-reactive antibodies (DRAs) were reduced to low levels. The patient 
      underwent successful heart transplantation after 6 weeks on a waiting list. 
      During the first week posttransplant, DRAs remained low. However, after the first 
      week, anti-HLA DRAs reappeared and increased slightly over a 3-week period and 
      then decreased slowly. Cytotoxic crossmatches were negative before and 3 week 
      after transplantation. No clinical rejection was encountered. The patient was 
      doing well 3 years after transplantation, and yearly clinical cardiac 
      investigations were all normal. Three hyperimmunized patients have now undergone 
      successful heart transplantation at our center using this desensitization 
      protocol. CONCLUSIONS: IA in combination with pretransplant immunosuppressive 
      drug treatment temporarily reduces antibody levels. The therapeutic levels of 
      drug treatment at the time of transplantation may be of crucial importance. The 
      treatment protocol resulted in freedom from rejection and other clinical adverse 
      events.
FAU - Bucin, Dragan
AU  - Bucin D
AD  - Department of Nephrology and Transplantation, Lund University, Malmo, Sweden. 
      dragan.bucin@skane.se
FAU - Gustafsson, Ronny
AU  - Gustafsson R
FAU - Ekmehag, Bjorn
AU  - Ekmehag B
FAU - Kornhall, Bjorn
AU  - Kornhall B
FAU - Algotsson, Lars
AU  - Algotsson L
FAU - Lund, Ulla
AU  - Lund U
FAU - Otto, Gisela
AU  - Otto G
FAU - Koul, Bansi
AU  - Koul B
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Isoantibodies)
RN  - 0 (Isoantigens)
SB  - IM
MH  - Adult
MH  - Biopsy
MH  - Child
MH  - Child, Preschool
MH  - Combined Modality Therapy
MH  - *Desensitization, Immunologic/methods
MH  - Drug Therapy, Combination
MH  - Flow Cytometry
MH  - Graft Rejection/immunology/*prevention & control
MH  - *Graft Survival
MH  - HLA Antigens/*immunology
MH  - *Heart Transplantation/adverse effects
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Immunosuppressive Agents/therapeutic use
MH  - Isoantibodies/*blood
MH  - Isoantigens/*immunology
MH  - Male
MH  - Sorption Detoxification
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2010/10/05 06:00
MHDA- 2011/01/08 06:00
CRDT- 2010/10/02 06:00
PHST- 2010/10/02 06:00 [entrez]
PHST- 2010/10/05 06:00 [pubmed]
PHST- 2011/01/08 06:00 [medline]
AID - 10.1097/TP.0b013e3181fa93c6 [doi]
PST - ppublish
SO  - Transplantation. 2010 Dec 15;90(11):1220-5. doi: 10.1097/TP.0b013e3181fa93c6.