SURVIVAL AND MONITORING OF SENSITIZED HEART PATIENTS RECEIVING A SINGLE PLASMAPHERESIS AND IVIG DOSE PRIOR TO TRANSPLANT REGARDLESS OF CROSSMATCH RESULTS.

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SURVIVAL AND MONITORING OF SENSITIZED HEART PATIENTS RECEIVING A SINGLE PLASMAPHERESIS AND IVIG DOSE PRIOR TO TRANSPLANT REGARDLESS OF CROSSMATCH RESULTS.
Mayra M. Lopez-Cepero Ph.D. ¹, William M. LeFor Ph.D. ¹, Lisa DiChiara R.N. ², Debbie Rhinde-Hoffman M.D. ³ and Mark Weston M.D. ³. ¹ Transplant Immunology Lab, LifeLink Foundation ; ² Tampa General Hospital and ³ LifeLink Health Care Institute, Tampa, FL, USA .

Death rate of patients awaiting a heart transplant is 7% nationwide and about 45% wait 2 years or longer for a t transplant (TPX). Our transplant program considers every patient with a Flow PRA > 10% for the plasmapheresis (PP) and IVIG protocol at the time of surgery. We studied 28 sensitized heart patients that received PP and IVIG at the time of surgery to determine if such protocol can be of benefit. The FCXM of patients prior to PP was 57% + and 43% neg. Following PP it was 47% +, 53% neg. From FCXM values prior to PP, 3 of the + and 2 of the neg group died. None of these deaths have been attributed to rejection. A biopsy score index in sensitized patients was no different vs the age matched control group. There was also no difference in the biopsy score index of those patients with a +FCXM vs neg FCXM groups after PP. However, patients with Class II Ab had more rejection episodes when compared to patients without in the sensitized population (p<0.01). There was no difference in survival between the 2 groups. Our study indicates that pre-operative PP and IVIG in sensitized patients awaiting heart TPX is effective with no difference in occurrence of rejection and survival. Post-TPX monitoring has a great impact in this group of patients since it has allow us to assess the effectiveness of IS drugs, detect active immune periods where increase or change in IS is necessary and differentiate among an Ab vs a cell mediated rejection.