Positive Panel Reactive Antibody Titers in Patients Bridged to Transplantation With a Mechanical Assist Device

Impact of Left Venticular Assist Device (LVAD)-mediated Humoral Sensitization on Post-transplant Outcomes

“…[13][14][15][16][17][18][19] Our findings, based on a much larger sample of patients, suggest that, in LVAD-supported patients who survive to transplantation, the rate of sensitization lies at the lower end of this spectrum, with 95% of these patients exhibiting a PRA of Ͻ25%. This level of sensitization is only marginally greater than rates measured in patients who did not receive an LVAD as a bridge to transplant.…”

To induce or not to induce: Do patients at greatest risk for fatal rejection benefit from cytolytic induction therapy?

“…Although this refinement of mechanical support as a risk factor for fatal rejection has not been specifically identified previously, this finding is in keeping with the known propensity for increasing sensitization with prolonged VAD support. [32][33][34] The differential impact of induction therapy as a function of risk factors for rejection death has been intuitively appreciated, but this analysis has provided the first quantitative insight into the relationship between the risk of fatal rejection and the likelihood that induction therapy would be of benefit or detriment. The progressive reduction in the routine use of induction therapy over this decade likely resulted from an increasing awareness of the potential deleterious effects of induction therapy with respect to infection and malignancy complications.…”

Clinical usefulness of a novel C1q assay to detect immunoglobulin G antibodies capable of fixing complement in sensitized pediatric heart transplant patients

“…[23][24][25][26][27][28] HLA antigens can be entered into UNet, a secure Internet-based transplant information database created by United Network for Organ Sharing (UNOS) as "avoids," and a virtual crossmatch (VXM) can be done to reduce the risk for antibody-mediated graft loss. This has contributed to prolonged waiting times, especially among very highly sensitized patients 29,30 and has disproportionately affected pediatric patients. 31 Some centers have elected not to list any "avoids," but this can lead to organ loss if the organs are incompatible.…”