How to Approach HLA Sensitization in Heart Transplant Candidates

Strategies for Prevention and Management of Heart Transplant Rejection

“…Recently, the International Society of Heart and Lung Transplantation (ISHLT) published the updated Guidelines for the care of heart transplant recipients [2][3][4][5]. Most common antibody screening is performed by sensitive solid phase assay.…”

The Outcomes of Highly Sensitized Heart Transplant Patients in South Korea: Insights and Perspectives

“…Non-specific circulating antibodies against class I and class II HLA used to be estimated by panel-reactive antibodies (PRAs), a recipient reactivity to antigens in a panel of random. 3) The calculated PRA (cPRA) is a quantitative measure, expressed as a percentage, indicating the portion of the general population for which a candidate recipient has circulating antibodies. 3) In 2015, the Immunology Division of the Korean Society of Laboratory Medicine developed a web-based cPRA calculator using data from Koreans ( http://cpra.inforang.com/form/form.html ).…”

“… 3) The calculated PRA (cPRA) is a quantitative measure, expressed as a percentage, indicating the portion of the general population for which a candidate recipient has circulating antibodies. 3) In 2015, the Immunology Division of the Korean Society of Laboratory Medicine developed a web-based cPRA calculator using data from Koreans ( http://cpra.inforang.com/form/form.html ). Presently, reporting cPRA using this tool has become standard in South Korea.…”

“… 10) The characteristics of recipient are likely to become similar to those of Western countries, due to the growing number of left ventricular assist device and retransplant patients in our lists, which are well-known strong factors of allo-sensitization. 3) Although numerous powerful desensitizing drugs such as tocilizumab are actively involved in desensitization in transplant expert centers, 2) 3) there is still a reimbursement issue in South Korea, making it challenging to prescribe them in reality. To improve the clinical outcomes for highly sensitized patients including AMR, now it’s time to investigate the listing mortality of sensitized patients on the wait list as well as to discuss the extension of reimbursement for the desensitizing drugs with the government and the transplant society.…”