Approach to the Sensitized Patient Awaiting Heart Transplantation

Abstract

The management of the sensitized patient awaiting heart transplant remains a challenge and an active area of research. The development of solid-phase immunoassays (including the C1q assay) has allowed high-resolution determination of antibodies most likely to be associated with antibody-mediated rejection and adverse outcomes. The precision of these techniques has permitted the adoption of the virtual crossmatch, substantially expanding the donor pool for sensitized patients and reducing wait times to transplant. Desensitization strategies continue to evolve, and the most effective therapies appear to be a combined approach utilizing antibody depletion, targeted B cell or plasma cell therapy, or immunomodulation. Further therapy in addition to cytolytic induction may be required at transplant, with judicious monitoring post-transplant for antibody rebound and rejection.