Abstract
Aim The presence of HLA antibodies in highly sensitized heart transplant candidates is a barrier that can prevent these individuals from receiving a lifesaving transplant. In an effort to downregulate their HLA antibodies, many candidates are treated with high-dose intravenous immunoglobulin. While this therapeutic approach to downregulation is successful in some subjects, others show no response. In this study, we attempted to identify factors associated with the successful downregulation of HLA antibodies in highly sensitized candidates eligible for heart transplantation. Methods Fifteen heart transplant candidates (ages 25–66) in this retrospective chart review had calculated panel reactive antibody (cPRA) levels ranging from 41 to 100%. In an effort to downregulate HLA antibodies, all subjects received monthly IVIG (2 g/kg; number of doses ranged from 2 to 25). Data evaluated included gender, age, race, BMI, ventricular assist device (VAD) type, desensitization regimen, PRA levels, antibodies present prior to and after IVIG, as well as history of blood transfusions, pregnancies, and previous transplants. Patients were considered responders to IVIG therapy if their original cPRA level decreased by ⩾50%, and non-responders if the decrease in cPRA was Results Patients included in this study had all received a VAD with a mean cPRA of 79.6 prior to IVIG treatment. IVIG efficacy was demonstrated by lower cPRA values ( p p = 0.005) in the responder group. Compared with the non-responder group, responders were more likely to be male ( p = 0.036) and females without previous pregnancies ( p = 0.036). Trends towards responsivenss were also seen with white race (0.106) and greater number of IVIG doses ( p = 0.085). Download high-res image (289KB) Download full-size image Conclusions IVIG is an appropriate treatment for highly sensitized patients eligible for heart transplant with patient-specific characteristics including male gender and pregnancy status, making certain patients more responsive to therapy than others.
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