#37-OR
PLASMAPHERESIS (PP) AND IVIG ENHANCE SURVIVAL OF ORTHOTOPIC (OHT) HEART TRANSPLANT RECIPIENTS.
Stephen Leech MD,PhD 1, Mayra Lopez-Cepero PhD 2, LeFor William PhD 2, Lisa DiCiara RN 2 and Mark Weston MD 2. 1 Pathology, Temple University, Philadelphia and 2 LifeLink, Tampa .
Previously, we reported that the combination of PP and IVIg allow sensitized patients to undergo OHT, even across a positive crossmatch. Here, we show that PP + IVIg together enhance survival of such recipients.
Since 1997, 33 sensitized pts. underwent OHT (group I). Methods for sensitization and crossmatch: CDC and/or flow cytometry. Group I got PP + IVIG together with standard immunosuppressives (SIS). Rejection was seen in 11 pts., findings strongly suggestive of a vascular (humoral) being identified in 5 of those cases. Four deaths occurred, 2 of them in the immediate post-op, 1 after almost 6 months, and 1 after almost 2 years post-OHT.
Patient survival was analysed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given SIS only (N = 276) showed enhanced survival of group I versus II at every time point considered (see table and figure; p=0.0414 by log-rank test.)
Follow-up range 2.5 months - 7.3 years post-OHT; average = 1 year. We conclude that the combination of PP and IVIG is useful in the treatment of the sensitized pt. undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch (11 pts.). More pts. need to be followed for longer periods to determine if the enhancement of survival by PP+IVIg is reproducible.PERCENT SURVIVAL at: 6 months 1 year 2 years Standard immunosuppression 82.3 78.8 71.1 Plasmapheresis + IVIg 90.7 90.5 86.3 