Abstract 2890: The Long Term Outcome Of Treated Presensitized Patients Who Undergo Heart Transplantation: Is It Successful?
Background: Sensitized patients prior to heart transplantation are reportedly at risk for hyperacute rejection and for poor outcome after heart transplantation. It is not known whether reduction of circulating antibodies pre-transplant alters post-transplant outcome.
Methods: Between July 1993 and July 2003 we reviewed 523 heart transplant patients of which 95 had pre-transplant PRAs >10%. 21/95 were treated pre-transplant for circulating antibodies. These 21 patients had PRAs greater than 10% (majority 50%–100%) and were treated with combination therapy including plasmapheresis and intravenous gamma globulin to reduce antibody counts. The 74 untreated patients with PRAs >10% (untreated presensitized group) and those patients with PRAs <10% (control group) were used for comparison. Routine post-transplant immunosuppression included triple drug therapy (tacrolimus, mycophenolate, and corticosteroids).
Results: Circulating antibody levels pre-transplant decreased from a median of 77.5 to 29.0% (p = 0.017), which allowed a negative prospective donor specific cross match and successful heart transplantation. Compared to the untreated presensitized group, and the control group, the treated sensitized patients had similar five year survival (81.1% vs. 75.7% vs. 71.4%, p=0.523) and freedom from cardiac allograft vasculopathy (74.3% vs. 72.7% vs. 76.2%, p=0.850).
Conclusion: Treatment of sensitized patients pre-transplant appears to result in comparable long term outcome after heart transplant.