4.3
#129
IMPACT OF PLASMAPHERESIS/IvIg THERAPIES ON ANTIBODY LEVELS AND GRAFT OUTCOME IN HEART AND LUNG RECIPIENTS.
Barbara O. Burgess , Scott Palmer , Stuart D. Russell , Bessie D. Reams , R. D. Davis , Walter Herczyk and Nancy L. Reinsmoen . Durham NC, Duke Univ. Med. Ctr., Clin. Transpl. Immunol. Lab, 27710, Pathology .
Heart and lung recipients (ht lg recips) with preformed anti-HLA antibodies (aby), are at high risk for early acute rejection (AR) and poor graft outcome. Plasmapheresis (PP) and IvIg protocols reduced the aby levels and thwart these deleterious effects. The aim of our study was to determine the impact of these therapies on aby levels and on graft outcome. Sera from 17 sensitized recips (17 ht, 10 lg) were tested for anti-HLA aby levels using FlowPRA® beads and titered at dilutions between 1:8 and 1:1,024. The clinical parameters for ht recips included cellular AR (CAR), and humoral AR (HAR) (C4D); for lg recips, ischemia reperfusion injury (IRI) and AR. Initially, the PP was performed daily with a weekly dose of IvIg and tapered until the aby titer decreased to a sustained level. Of the 5 ht recips with DSA, 2 had HAR. None of the 3 ht recips with the highest Class I directed antibody titers (1:512) had AR. The overall CAR rate was 24% (4/17), comparable to the 25% CAR rate observed for all our ht recips, and lower than the 55% AR rate previously reported for sensitized recips. None of the 10 lg recips had DSA. The 2 lg recips with the highest titer (>1:512) Class I directed antibodies also experienced IRI, suggesting that anti-HLA antibodies may play a role in this type of injury. The other lg recips had titers from 1:64-1:80 . Overall, a marked beneficial effect on acute graft failure was noted. Of the four recips tested posttx, one showed no change in titers, and 3 showed decrease to negative or to a stable titer by 3 months posttx. Thus, the PP/IvIg protocols offer an opportunity for intervention aimed at improving early graft function and allows for the individualization of therapy.