546: No harm, no foul? The prospective treatment of sensitized heart transplant recipients with plasmapheresis and IVIG – three year follow-up

Abstract

Purpose The panel reactive antibody (PRA) screen is used to identify sensitized (SENS) patients awaiting heart transplantation. Patients with elevated PRAs include multiparous women, those who received blood transfusions, and those on mechanical circulatory support. SENS patients have a prolonged waiting time. The increased use of mechanical circulatory support ensures that patients with elevated PRAs and positive crossmatches will be more common. SENS patients were treated with plasmapheresis and IVIG immediately prior to transplantation. We report five year follow-up findings on the effect of the treatment on survival, frequency of rejection, and coronary vasculopathy. Methods and Materials 26 of 52 patients awaiting heart transplant were found to be sensitized (SENS) using flow cytometry. SENS patients underwent plasmapheresis followed by 20 gm of IVIG immediately prior to heart transplantation. The SENS group was compared to a matching group of patients with PRAs Results Comparisons of the SENS and NONSENS patients revealed that survival (p Conclusions Preoperative plasmapheresis and IVIG in SENS patients awaiting heart transplantation is effective with no difference in the incidence of survival, rejection or coronary vasculopathy after five years. SENS patients with PRA Class II positive did not have a greater chance of rejection.