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Desensitization in Total Artificial Heart Patients

2016; Elsevier BV; Volume: 35; Issue: 4 Linguagem: Inglês

10.1016/j.healun.2016.01.816

1557-3117

Jonathan R. Neyer, M. Kittleson, J Patel, L. Czer, T. Aintablian, G. Rodriguez, R. Jocson, C. Runyan, D. Chang, J. Moriguchi, Alfredo Trento, Jon Kobashigawa, Francisco A. Arabía,

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Patients with biventricular failure who require a total artificial heart (TAH) may develop circulating antibodies due to multiple blood transfusions. TAH also provides a durable form of mechanical circulatory support for patients with antibody sensitization otherwise unable to tolerate desensitization protocols. If the calculated panel reactive antibody (cPRA) screen is >50% then our program considers these patients for desensitization therapy. Desensitization with either rituximab, bortezomib, carfilzomib or plasmapharesis has been demonstrated by our program to result in significant reduction of circulating antibodies. It has not been demonstrated whether desensitization treatment in TAH patients is effective and safe. We sought to examine this question. Between 2014 and 2015 we assessed 40 TAH patients. We found 3 patients who had a cPRA> 50% who underwent subsequent desensitization. These patients underwent desensitization with rituximab (n = 3), bortezomib (n = 3), carfilzomib (n = 1) and plasmapheresis (n = 3). Follow up blood work for circulating antibodies after completion of desensitization therapy was obtained. Adverse events including infection post-desensitization treatment was also recorded. The average cPRA was 86.7% prior to TAH, 98.7% following TAH and 94.3% following desensitization. TAH patients had an average CPRA decrease of 4.4% with desensitization. All three patients had infections in the month following desensitization. 2 of 3 patients have subsequently received tissue heart transplants; 1 patient died from complications of an intracerebral hemorrhage prior to transplant.Tabled 1Calculated Panel Reactive Antibody (%)PatientPrior to TAHFollowing TAHAfter Desensitization19410088266989631009899Mean86.798.794.3 Open table in a new tab Desensitization in highly sensitized TAH patients does not appear to be very effective, but numbers are small. There is a high rate of infection in these patients undergoing desensitization and increased monitoring for infection should be pursued. A larger cohort of patients is needed for further study.