Successful Heart Transplantation After Desensitization in a Patient With Extremely High Panel-Reactive Antibody Levels and Pretransplant Donor-Specific Antibody: A Case Report

• Published in: Transplantation proceedings Vol. 50; no. 10; pp. 4067 - 4070
• Main Authors: Nakamura, Y., Yoshioka, D., Miyagawa, S., Yoshikawa, Y., Hata, H., Matsuura, R., Toda, K., Sawa, Y.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Adult; Antibodies; Desensitization, Immunologic - methods; Female; Graft Rejection - immunology; Graft Survival - immunology; Heart Transplantation - methods; HLA Antigens - immunology; Humans; Transplantation, Homologous
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.08.058

Elevated panel-reactive antibody (PRA) levels serve as a significant risk factor for allograft survival and episodes of rejection after heart transplantation (HTX). Patients with high PRA levels tend to show expressions of donor-specific human leukocyte antigen antibodies (DSA), which can cause catastrophic hyperacute rejection after HTX. Therefore, such highly sensitized patients are required to undergo strategic perioperative desensitization therapy. We describe a successful HTX after desensitization in a patient with extremely high PRA levels and pretransplant DSA positivity. •Highly sensitized patient underwent heart transplantation with desensitization.•Plasma exchange is a reliable desensitization treatment modality.•Plasma exchange should be performed in a timely fashion perioperatively.•Eliminating donor-specific antibody might be crucial to avoid humoral rejection.