PMID- 31090629
OWN - NLM
STAT- MEDLINE
DCOM- 20200327
LR  - 20200511
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 24
IP  - 3
DP  - 2019 Jun
TI  - Desensitization for sensitized patients awaiting heart transplant.
PG  - 233-238
LID - 10.1097/MOT.0000000000000639 [doi]
AB  - PURPOSE OF REVIEW: This review summarizes contemporary desensitization strategies 
      for patients awaiting cardiac transplantation in an era when specific management 
      is still somewhat controversial. RECENT FINDINGS: The number of sensitized 
      patients awaiting heart transplantation is rising. Clinical assessment of 
      antibody levels is mostly focused on human leukocyte antigen (HLA) antibodies. 
      Sensitization to HLA antigens increases the risk of antibody medicated rejection 
      and cardiac allograft vasculopathy after transplant, thus translates to reduced 
      access to compatible donors and increased wait time to transplant. 
      Desensitization therapy is commonly considered in listed patients with cPRA more 
      than 50%, to either decrease the amount of circulating anti-HLA antibodies, 
      reduce the antibody production, or a combination of both. Despite promising 
      results on specific therapies (e.g., plasmapheresis, intravenous immunoglobulin, 
      rituximab, bortezomib), there is a significant gap in knowledge on 
      desensitization therapies in heart transplantation. Most data are from small 
      observational studies and extrapolated from nonheart solid organ transplants. 
      SUMMARY: Management of the sensitized patient awaiting heart transplant is 
      individualized. Desensitization can facilitate negative cross-match and 
      successful transplantation, but is associated with significant cost and potential 
      adverse effects. The long-term outcomes of desensitization therapy remain to be 
      determined, further emphasizing the importance of personalizing the treatment 
      approach to each patient.
FAU - Byku, Mirnela
AU  - Byku M
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, North Carolina, USA.
FAU - Chang, Patricia P
AU  - Chang PP
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Desensitization, Immunologic/*methods
MH  - Graft Rejection/immunology/prevention & control
MH  - HLA Antigens/immunology
MH  - Heart Transplantation/*methods
MH  - Humans
EDAT- 2019/05/16 06:00
MHDA- 2020/03/28 06:00
CRDT- 2019/05/16 06:00
PHST- 2019/05/16 06:00 [entrez]
PHST- 2019/05/16 06:00 [pubmed]
PHST- 2020/03/28 06:00 [medline]
AID - 00075200-201906000-00005 [pii]
AID - 10.1097/MOT.0000000000000639 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2019 Jun;24(3):233-238. doi: 
      10.1097/MOT.0000000000000639.