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How to deal with presensitized candidates for heart transplantation?

Bhimaraj, Arvind; Taylor, David O.

Current Opinion in Organ Transplantation: October 2011 - Volume 16 - Issue 5 - p 529–535
doi: 10.1097/MOT.0b013e32834a8c4d
Cardiac transplantation: Edited by Bruno Meiser
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Purpose of review With increasing utilization of assist devices and adoption of calculated panel-reactive antibody (cPRA), the number of presensitized patients being listed for heart transplantation is increasing. An effort to standardize identification and management of such patients is paramount and recently initiated in the heart transplant community. The current review describes the basic concepts of presensitization and details the most relevant work including the latest advancements in this area.

Recent findings More sensitive techniques in identifying presensitized patients have posed challenges in understanding the clinical relevance and implications of such testing. cPRA has been shown to benefit presensitized heart transplant patients. De-sensitization strategies have never been studied in a large clinical trial setting but a combination of plasmapheresis and intravenous immunoglobulin has been shown to be beneficial in small studies. Long-term positive outcomes of de-sensitization have been recently reported. Newer agents like alemtuzumab, bortezomib and complement inhibitors have been reported in case reports and series with promising results as de-sensitization strategy.

Summary Data specific to strategies and therapies in heart transplantation are sparse and most knowledge stems from other organ transplantation. Consensus efforts to standardize care and also advance research in this area were initiated recently with hope for improving care for these patients.

Kaufman Center for Heart failure, Heart and Vascular Institute, Cleveland Clinic Foundation, Ohio, USA

Correspondence to David O. Taylor, 9500, Euclid Avenue, Desk-J-3–4, Cleveland Clinic, Cleveland, OH, USATel: +1 216 444 2492; fax: +1 216 444 6193; e-mail: taylord2@ccf.org

© 2011 Lippincott Williams & Wilkins, Inc.