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Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients

BACKGROUND. Sensitization remains a barrier to heart transplantation (HT). Perioperative desensitization strategies have been described; however, a paucity of evidence exists to demonstrate efficacy and safety in HT. METHODS. This single-center, retrospective study consisted of adults who received a...

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Autores principales: Plazak, Michael E., Gale, Stormi E., Reed, Brent N., Hammad, Sara, Ton, Van-Khue, Kaczorowski, David J., Madathil, Ronson J., Ravichandran, Bharath
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837881/
https://www.ncbi.nlm.nih.gov/pubmed/33521247
http://dx.doi.org/10.1097/TXD.0000000000001111
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author Plazak, Michael E.
Gale, Stormi E.
Reed, Brent N.
Hammad, Sara
Ton, Van-Khue
Kaczorowski, David J.
Madathil, Ronson J.
Ravichandran, Bharath
author_facet Plazak, Michael E.
Gale, Stormi E.
Reed, Brent N.
Hammad, Sara
Ton, Van-Khue
Kaczorowski, David J.
Madathil, Ronson J.
Ravichandran, Bharath
author_sort Plazak, Michael E.
collection PubMed
description BACKGROUND. Sensitization remains a barrier to heart transplantation (HT). Perioperative desensitization strategies have been described; however, a paucity of evidence exists to demonstrate efficacy and safety in HT. METHODS. This single-center, retrospective study consisted of adults who received an HT. Perioperative desensitization was initiated if virtual crossmatch or flow-cytometry crossmatch was positive. Therapy consisted of plasmapheresis, intravenous immunoglobulin, and rabbit antithymocyte globulin. Historical controls received standard immunosuppression or induction. The primary endpoint was survival at 12 mo. Secondary endpoints included freedom from acute rejection, cardiac allograft vasculopathy (CAV), and infectious complications. RESULTS. Of the 104 patients included, 48 received no induction, 46 received induction, and 10 underwent perioperative desensitization. No differences were observed in the primary endpoint at 12 mo (90.0% versus 97.9%, P = 0.25 for desensitization versus no-induction; 90.0% versus 100%, P = 0.72 for desensitization versus induction). Rates of acute rejection were lower with induction and desensitization compared with no-induction. There were no significant differences in CAV between the groups. Infectious complications were also similar among the groups (10.0% versus 16.7%, P = 0.62 for desensitization versus no-induction; 10.0% versus 30.4%, P = 0.34 for desensitization versus induction). CONCLUSIONS. This study suggests that a perioperative desensitization strategy triggered by positive virtual crossmatch or flow-cytometry crossmatch allows for successful transplantation of sensitized HT recipients and results in acceptable rates of survival, rejection, CAV, and infection at 12 mo.
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spelling pubmed-78378812021-01-28 Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients Plazak, Michael E. Gale, Stormi E. Reed, Brent N. Hammad, Sara Ton, Van-Khue Kaczorowski, David J. Madathil, Ronson J. Ravichandran, Bharath Transplant Direct Heart Transplantation BACKGROUND. Sensitization remains a barrier to heart transplantation (HT). Perioperative desensitization strategies have been described; however, a paucity of evidence exists to demonstrate efficacy and safety in HT. METHODS. This single-center, retrospective study consisted of adults who received an HT. Perioperative desensitization was initiated if virtual crossmatch or flow-cytometry crossmatch was positive. Therapy consisted of plasmapheresis, intravenous immunoglobulin, and rabbit antithymocyte globulin. Historical controls received standard immunosuppression or induction. The primary endpoint was survival at 12 mo. Secondary endpoints included freedom from acute rejection, cardiac allograft vasculopathy (CAV), and infectious complications. RESULTS. Of the 104 patients included, 48 received no induction, 46 received induction, and 10 underwent perioperative desensitization. No differences were observed in the primary endpoint at 12 mo (90.0% versus 97.9%, P = 0.25 for desensitization versus no-induction; 90.0% versus 100%, P = 0.72 for desensitization versus induction). Rates of acute rejection were lower with induction and desensitization compared with no-induction. There were no significant differences in CAV between the groups. Infectious complications were also similar among the groups (10.0% versus 16.7%, P = 0.62 for desensitization versus no-induction; 10.0% versus 30.4%, P = 0.34 for desensitization versus induction). CONCLUSIONS. This study suggests that a perioperative desensitization strategy triggered by positive virtual crossmatch or flow-cytometry crossmatch allows for successful transplantation of sensitized HT recipients and results in acceptable rates of survival, rejection, CAV, and infection at 12 mo. Lippincott Williams & Wilkins 2021-01-26 /pmc/articles/PMC7837881/ /pubmed/33521247 http://dx.doi.org/10.1097/TXD.0000000000001111 Text en Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Heart Transplantation
Plazak, Michael E.
Gale, Stormi E.
Reed, Brent N.
Hammad, Sara
Ton, Van-Khue
Kaczorowski, David J.
Madathil, Ronson J.
Ravichandran, Bharath
Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients
title Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients
title_full Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients
title_fullStr Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients
title_full_unstemmed Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients
title_short Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients
title_sort clinical outcomes of perioperative desensitization in heart transplant recipients
topic Heart Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837881/
https://www.ncbi.nlm.nih.gov/pubmed/33521247
http://dx.doi.org/10.1097/TXD.0000000000001111
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