PMID- 27216504
OWN - NLM
STAT- MEDLINE
DCOM- 20180413
LR  - 20220317
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 35
IP  - 8
DP  - 2016 Aug
TI  - Desensitization strategies in adult heart transplantation-Will persistence pay 
      off?
PG  - 962-72
LID - S1053-2498(16)30074-2 [pii]
LID - 10.1016/j.healun.2016.03.021 [doi]
AB  - Strategies are needed to enable successful heart transplantation in highly 
      sensitized patients. Immunologic challenges from sensitization to human leukocyte 
      antigen (HLA) reduce access to compatible donors, extend waiting times to 
      transplant, and increase the risks of antibody-mediated rejection and cardiac 
      allograft vasculopathy after transplant. The prime goal of desensitization is to 
      increase access to transplantation through expansion of the donor organ pool. 
      Existing therapies are directed at key components of the humoral immune response 
      with newer biologically based regimens able to target plasma cells as the source 
      of antibody production, as well as complement activation that has a central role 
      in antibody-mediated injury. Despite the emergence of early promising results for 
      these agents, a significant knowledge gap remains with the current data for 
      desensitization, extrapolated mostly from non-heart solid-organ transplants and 
      small observational studies. Notably, no approach has demonstrated significant 
      and sustainable reductions in HLA antibody pre-transplant, and the ideal 
      desensitization strategy remains elusive. In addition, clinical tools to evaluate 
      the humoral response and efficacy of therapy are limited, focusing almost 
      exclusively on HLA antibody detection. Importantly, desensitization is associated 
      with significant costs and potential risks, and overall long-term outcomes and 
      cost-effectiveness have not been sufficiently evaluated. Investigation is ongoing 
      into the development of a clinically effective desensitization strategy in heart 
      transplantation.
CI  - Copyright (c) 2016 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - Chih, Sharon
AU  - Chih S
AD  - Heart Failure and Transplant, Division of Cardiology, University of Ottawa Heart 
      Institute, Ottawa, Ontario, Canada. Electronic address: schih@ottawaheart.ca.
FAU - Patel, Jignesh
AU  - Patel J
AD  - Heart Transplant Program, Cedars-Sinai Heart Institute, Los Angeles, California, 
      USA.
LA  - eng
PT  - Editorial
DEP - 20160331
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 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Adult
MH  - Desensitization, Immunologic
MH  - Graft Rejection
MH  - HLA Antigens
MH  - *Heart Transplantation
MH  - Humans
MH  - Immunoglobulins, Intravenous
MH  - Isoantibodies
MH  - Kidney Transplantation
OTO - NOTNLM
OT  - antibody
OT  - complement
OT  - desensitization
OT  - heart transplantation
OT  - human leukocyte antigen sensitization
OT  - intravenous immunoglobulin
OT  - plasmapheresis
EDAT- 2016/05/25 06:00
MHDA- 2018/04/14 06:00
CRDT- 2016/05/25 06:00
PHST- 2015/11/11 00:00 [received]
PHST- 2016/01/25 00:00 [revised]
PHST- 2016/03/18 00:00 [accepted]
PHST- 2016/05/25 06:00 [entrez]
PHST- 2016/05/25 06:00 [pubmed]
PHST- 2018/04/14 06:00 [medline]
AID - S1053-2498(16)30074-2 [pii]
AID - 10.1016/j.healun.2016.03.021 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2016 Aug;35(8):962-72. doi: 
      10.1016/j.healun.2016.03.021. Epub 2016 Mar 31.