Top Things to Know: Sensitization in Heart Transplantation Emerging Knowledge
Published: February 19, 2019
- Sensitization, defined as the presence of circulating antibodies, presents challenges for heart transplant recipients and physicians.
- The presence of sensitization can also negatively impact post-transplant outcomes.
- The presence of sensitization can restrict access to organ transplantation by limiting the available donor pool, increasing wait time, thus increasing the risk of waitlist mortality and morbidity due to progression of disease.
- Desensitization therapies are expensive and expose patients to augmented immunosuppression and corresponding complications, but may be an option if the patient is found to have sensitization.
- Risk factors for sensitization include: prior exposure to human leukocyte antigen (HLA) types via prior transplant, pregnancy, transfusion, or human tissue allografts (e.g. cardiac valves, pericardial or dural patches, etc.). Other risk factors include: black ethnicity, viral infection, influenza vaccine and ventricular assist devices.
- To date, management of sensitization is not standardized, and unfortunately current therapies have not yielded consistent results.
- Current therapies include: Antibody suppression and removal using intravenous immunoglobulin (IVIg), plasmapheresis, and antibody therapy. Newer strategies with more specific targets are being investigated.
- This statement provides clinical pearls for healthcare providers including: cardiologists, transplant cardiologists, transplant clinical staff, pharmacology and transplant immunologists to aid in management of persons with sensitization or at risk for it.
- Methods for HLA detection and interpretation are discussed within this statement. Examples of these methods include: Complement-dependent lymphocytotoxicity (CDC), flow cytometry, ELISA and Luminex (flow Cytometry).
- Managing the sensitized patient and the challenges of managing sensitization in pediatric patients are also discussed as well as novel therapies for treatment of sensitization.
Citation
Colvin MM, Cook JL, Chang PP, Hsu DT, Kiernan MS, Kobashigawa JA, Lindenfeld J, Masri SC, Miller DV, Rodriguez ER, Tyan DB, Zeevi A, on behalf of the American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology, Council on Lifelong Congenital Heart Disease and Heart Health in the Young, Council on Cardiovascular and Stroke Nursing, and Council on Cardiovascular Surgery and Anesthesia. Sensitization in heart transplantation: emerging knowledge: a scientific statement from the American Heart Association [published online ahead of print February 19, 2019]. Circulation. DOI: 10.1161/CIR.0000000000000598.