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Three year post heart transplant outcomes of desensitized durable mechanical circulatory support patients

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Author(s)
Jong-Chan YounDarae KimMi-Hyang JungJin-Jin KimIn-Cheol KimHye Sun LeeJin-Oh ChoiEun-Seok JeonKeith NishiharaOsamu SeguchiEvan P KransdorfDavid H ChangMichelle M KittlesonJignesh K PatelRobert M ColeJaime D MoriguchiDanny RamzyFardad EsmailianJon A Kobashigawa
Keimyung Author(s)
Kim, In Cheol
Department
Dept. of Internal Medicine (내과학)
Journal Title
J Heart Lung Transplant
Issued Date
2023
Volume
42
Issue
10
Keyword
desensitization therapyheart transplantationinfectionmechanical circulatory supportprognosis
Abstract
Background:
The risks and benefits of desensitization therapy (DST) in highly sensitized mechanical circulatory support (MCS) patients are not well known. We investigated 3 year post-transplant outcomes of desensitized durable MCS patients.

Methods:
Among 689 consecutively enrolled heart transplantation recipients between 2010 and 2016, we categorized them into Group A (desensitized MCS patients, n = 21), Group B (desensitized non-MCS patients, n = 28) and Group C (all nondesensitized patients, n = 640). Post-transplant outcomes included the incidence of primary graft dysfunction, 3-year survival, freedom from cardiac allograft vasculopathy, nonfatal major adverse cardiac events, any treated rejection, acute cellular rejection, antibody mediated rejection (AMR) and infectious complications.

Results:
The types of DST in Groups A and B were similar and included combinations of rituximab/intravenous immunoglobulin and plasmapheresis/bortezomib. Group A, compared with Group B, showed significantly higher pre-DST panel reactive antibody (PRA) (92.2 ± 9.8 vs. 83.3 ± 15.6, P = 0.007) and higher PRA reduction after DST (-22.2 ± 26.9 vs. -6.3 ± 7.5, P = 0.015). Groups A and C showed comparable primary graft dysfunction, 3-year survival, freedom from cardiac allograft vasculopathy, nonfatal major adverse cardiac events, any treated rejection, acute cellular rejection, and AMR. Although statistically not significant, Group A showed numerically higher 3-year freedom from AMR than Group B. Infectious complications were similar in both Groups A and B.

Conclusions:
DST for MCS patients showed significant PRA reduction, resulting in an expansion of the donor pool. The post-transplant outcome of desensitized MCS patients showed comparable clinical outcomes to non-desensitized control patients in the same study period, revealing the safety and efficacy of DST.
Keimyung Author(s)(Kor)
김인철
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1557-3117
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S105324982301851X
DOI
10.1016/j.healun.2023.05.001
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45117
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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