Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation
Patients with a PRA > 10% are considered to be at greater risk for the development of not only acute cellular and humoral rejection but also increased mortality when compared to nonsensitized patients following transplantation. All patients with a PRA > 10% at our institution are treated with...
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Published in | The Journal of heart and lung transplantation Vol. 18; no. 7; pp. 701 - 706 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Elsevier Inc
1999
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Abstract | Patients with a PRA > 10% are considered to be at greater risk for the development of not only acute cellular and humoral rejection but also increased mortality when compared to nonsensitized patients following transplantation. All patients with a PRA > 10% at our institution are treated with plasmapheresis and intravenous immunoglobulin G immediately prior to cardiac transplantation.
Sixteen (Group 1) of 118 patients awaiting cardiac transplantation were found to be sensitized. These patients underwent plasmapheresis followed by 20 gm of intravenous immunoglobulin G (IVIG) immediately prior to cardiac transplantation. Group 1 was compared to the remaining 102 patients with a PRA < 10% (Group 2).
Despite more patients in Group 1 having a positive crossmatch, pulmonary hypertension, and requiring mechanical circulatory support, there was no statistically significant difference in length of stay or mortality at a mean follow-up of 21.6 ± 15.0 months. There was no difference in the occurrence of mild, moderate or severe cellular rejection or humoral rejection in these sensitized patients when compared to Group 2.
Pretransplant plasmapheresis followed by intravenous immunoglobulin G may be an effective therapy that obviates the need for a prospective crossmatch and allows sensitized patients to undergo cardiac transplantation. There is no increase in the post transplant length of stay, occurrence of rejection or short term mortality. Long term follow up is necessary to evaluate whether there is a difference in the development of late rejection, transplant vasculopathy and survival. |
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AbstractList | Patients with a PRA > 10% are considered to be at greater risk for the development of not only acute cellular and humoral rejection but also increased mortality when compared to nonsensitized patients following transplantation. All patients with a PRA > 10% at our institution are treated with plasmapheresis and intravenous immunoglobulin G immediately prior to cardiac transplantation.
Sixteen (Group 1) of 118 patients awaiting cardiac transplantation were found to be sensitized. These patients underwent plasmapheresis followed by 20 gm of intravenous immunoglobulin G (IVIG) immediately prior to cardiac transplantation. Group 1 was compared to the remaining 102 patients with a PRA < 10% (Group 2).
Despite more patients in Group 1 having a positive crossmatch, pulmonary hypertension, and requiring mechanical circulatory support, there was no statistically significant difference in length of stay or mortality at a mean follow-up of 21.6 ± 15.0 months. There was no difference in the occurrence of mild, moderate or severe cellular rejection or humoral rejection in these sensitized patients when compared to Group 2.
Pretransplant plasmapheresis followed by intravenous immunoglobulin G may be an effective therapy that obviates the need for a prospective crossmatch and allows sensitized patients to undergo cardiac transplantation. There is no increase in the post transplant length of stay, occurrence of rejection or short term mortality. Long term follow up is necessary to evaluate whether there is a difference in the development of late rejection, transplant vasculopathy and survival. |
Author | Pisani, Barbara A Malinowska, Krystyna Mendez, Jose Lawless, Christine E Silver, Marc A Radvany, Ruta Robinson, John A Mullen, G.Martin |
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Copyright | 1999 International Society for Heart and Lung Transplantation |
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References | Singh, Thompson, Griffith (BIB1) 1983; 28 McIntyre, Higgins, Britton (BIB12) 1996; 62 Kobashigawa, Sabad, Drinkwater (BIB3) 1996; 94 Lavee, Kormos, Duquesnoy (BIB7) 1991; 10 Cochrane, Benson, Williams, Bergin, Esmore (BIB4) 1992; 24 Glotz, Haymann, Sansonetti (BIB11) 1993; 56 Cocoanougher, Ballantyne, Pollack (BIB6) 1993; 25 Loh, Bergin, Couper, Mudge (BIB2) 1994; 13 Backman, Fellstrom, Frodin (BIB9) 1989; 21 Ratkovec, Hammond, O’Connell (BIB10) 1992; 54 Costanzo-Nordin (BIB5) 1992; 11 Robinson, Radvany, Mullen, Garrity (BIB13) 1997; 1 Hodge, Klingman, Koo, Nally (BIB8) 1994; 26 |
References_xml | – volume: 24 start-page: 169 year: 1992 end-page: 170 ident: BIB4 article-title: Effect of HLA-DR matching on rejection after cardiac transplantation publication-title: Transplantation Proc contributor: fullname: Esmore – volume: 26 start-page: 2750 year: 1994 end-page: 2751 ident: BIB8 article-title: Pretransplant removal of anti-HLA antibodies by plasmapheresis and continued suppression on cyclosporine based therapy after heart/kidney transplant publication-title: Transplantation Proc contributor: fullname: Nally – volume: 62 start-page: 691 year: 1996 end-page: 693 ident: BIB12 article-title: Utilization of intravenous immunoglobulin to ameliorate alloantibodies in a highly sensitized patient with a cardiac assist device awaiting heart transplantation publication-title: Transplantation contributor: fullname: Britton – volume: 94 start-page: II294 year: 1996 end-page: II7 ident: BIB3 article-title: Pretransplant panel reactive antibody screens publication-title: Circulation contributor: fullname: Drinkwater – volume: 54 start-page: 651 year: 1992 end-page: 655 ident: BIB10 article-title: Outcome of cardiac transplant recipients with a positive donor-specific crossmatch—preliminary results with plasmapheresis publication-title: Transplantation contributor: fullname: O’Connell – volume: 25 start-page: 233 year: 1993 end-page: 236 ident: BIB6 article-title: Degree of HLA mismatch as a predictor of death from allograft arteriopathy after heart transplant publication-title: Transplantation Proc contributor: fullname: Pollack – volume: 21 start-page: 762 year: 1989 end-page: 763 ident: BIB9 article-title: Successful transplantation in highly sensitized patients publication-title: Transplantation Proc contributor: fullname: Frodin – volume: 56 start-page: 335 year: 1993 end-page: 337 ident: BIB11 article-title: Suppression of HLA-specific alloantibodies by high-dose intravenous immunoglobulins (IVIG) publication-title: Transplantation contributor: fullname: Sansonetti – volume: 11 start-page: S90 year: 1992 end-page: S103 ident: BIB5 article-title: Cardiac allograft vasculopathy: relationship with acute cellular rejection and histocompatibility publication-title: J Heart Lung Transplant contributor: fullname: Costanzo-Nordin – volume: 10 start-page: 921 year: 1991 end-page: 930 ident: BIB7 article-title: Influence of panel reactive antibody and lymphocytotoxic crossmatch on survival after heart transplantation publication-title: J Heart Lung Transplant contributor: fullname: Duquesnoy – volume: 1 start-page: 147 year: 1997 end-page: 151 ident: BIB13 article-title: Plasmapheresis followed by intravenous immunoglobulin in presensitized patients awaiting thoracic organ transplantation publication-title: Ther Apheresis contributor: fullname: Garrity – volume: 28 start-page: 56 year: 1983 end-page: 66 ident: BIB1 article-title: Histocompatibility in cardiac transplantation with particular reference to immunopathology of positive serologic crossmatch publication-title: Clin Immuno Immunopath contributor: fullname: Griffith – volume: 13 start-page: 194 year: 1994 end-page: 201 ident: BIB2 article-title: Role of panel reactive antibody crossreactivity in predicting survival after orthotopic heart transplantation publication-title: J Heart Lung Transplant contributor: fullname: Mudge |
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Title | Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation |
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