Review article
PREPARATION OF HIGHLY HLA-SENSITIZED PATIENT FOR HEART TRANSPLANTATION: FIRST DOCUMENTED CASE IN CROATIA
BRUNA BRUNETTA GAVRANIĆ
; Department of Dialysis, Zagreb, Croatia
NIKOLINA BAŠIĆ-JUKIĆ
; Department of Dialysis, Zagreb, Croatia
IVA RATKOVIĆ-GUSIĆ
; Department of Dialysis, Zagreb, Croatia
NATALIJA MARTINEZ
; Department of Tissue Typing, Zagreb, Croatia
VIŠNJA IVANČAN
; Department of Anesthesiology, Zagreb University Hospital Center, Zagreb, Croatia
PETAR KES
; Department of Dialysis, Zagreb, Croatia
Abstract
The presence of human leukocyte antigen (HLA) poses a significant therapeutic challenge in solid organ transplantation. Sensitized patients (panel reactive antibody, PRA >10%) receiving a heart transplant are at an increased risk of developing several clinical syndromes that influence short-term, and possibly also long-term patient survival. We present a case of immune system modulation in a highly sensitized patient awaiting heart transplantation. To our knowledge, this is the first case of desensitization therapy in solid organ transplantation done in Croatia. The patient with decompensated primary dilated cardiomyopathy received left ventricular assist device as a bridge to heart transplantation. Pre-transplantation evaluation revealed the presence of fungal pneumonia and high sensitization to HLA antibodies (PRA 97%). Desensitization protocol consisted of mycophenolate mofetil, tacrolimus, intravenous immune globulin and preoperative plasmapheresis along with previously initiated antifungal therapy. We withheld the application of rituximab until after resolution of pneumonia, but our protocol lowered PRA to 6% even without it. Unfortunately, during the next several weeks, a suitable donor was not found and our patient died form multiorgan failure. Avoidance of allosensitization by early referral to transplantation center, early transplantation, and avoidance of transfusions are very important when treating a potential transplant recipient. In this way, waiting time to ransplantation, development of posttransplantation complications and mortality are reduced.
Keywords
heart transplantation; desensitization; plasma exchange; anti-HLA antibodies
Hrčak ID:
89607
URI
Publication date:
1.3.2011.
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