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Antibody desensitization therapy in highly sensitized lung transplant candidates.

Publication ,  Journal Article
Snyder, LD; Gray, AL; Reynolds, JM; Arepally, GM; Bedoya, A; Hartwig, MG; Davis, RD; Lopes, KE; Wegner, WE; Chen, DF; Palmer, SM
Published in: Am J Transplant
April 2014

As HLAs antibody detection technology has evolved, there is now detailed HLA antibody information available on prospective transplant recipients. Determining single antigen antibody specificity allows for a calculated panel reactive antibodies (cPRA) value, providing an estimate of the effective donor pool. For broadly sensitized lung transplant candidates (cPRA ≥ 80%), our center adopted a pretransplant multi-modal desensitization protocol in an effort to decrease the cPRA and expand the donor pool. This desensitization protocol included plasmapheresis, solumedrol, bortezomib and rituximab given in combination over 19 days followed by intravenous immunoglobulin. Eight of 18 candidates completed therapy with the primary reasons for early discontinuation being transplant (by avoiding unacceptable antigens) or thrombocytopenia. In a mixed-model analysis, there were no significant changes in PRA or cPRA changes over time with the protocol. A sub-analysis of the median fluorescence intensity (MFI) change indicated a small decline that was significant in antibodies with MFI 5000-10,000. Nine of 18 candidates subsequently had a transplant. Posttransplant survival in these nine recipients was comparable to other pretransplant-sensitized recipients who did not receive therapy. In summary, an aggressive multi-modal desensitization protocol does not significantly reduce pretransplant HLA antibodies in a broadly sensitized lung transplant candidate cohort.

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Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

April 2014

Volume

14

Issue

4

Start / End Page

849 / 856

Location

United States

Related Subject Headings

  • Survival Rate
  • Surgery
  • Risk Factors
  • Prognosis
  • Plasmapheresis
  • Middle Aged
  • Male
  • Lung Transplantation
  • Lung Diseases
  • Isoantibodies
 

Citation

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Snyder, L. D., Gray, A. L., Reynolds, J. M., Arepally, G. M., Bedoya, A., Hartwig, M. G., … Palmer, S. M. (2014). Antibody desensitization therapy in highly sensitized lung transplant candidates. Am J Transplant, 14(4), 849–856. https://doi.org/10.1111/ajt.12636
Snyder, L. D., A. L. Gray, J. M. Reynolds, G. M. Arepally, A. Bedoya, M. G. Hartwig, R. D. Davis, et al. “Antibody desensitization therapy in highly sensitized lung transplant candidates.Am J Transplant 14, no. 4 (April 2014): 849–56. https://doi.org/10.1111/ajt.12636.
Snyder LD, Gray AL, Reynolds JM, Arepally GM, Bedoya A, Hartwig MG, et al. Antibody desensitization therapy in highly sensitized lung transplant candidates. Am J Transplant. 2014 Apr;14(4):849–56.
Snyder, L. D., et al. “Antibody desensitization therapy in highly sensitized lung transplant candidates.Am J Transplant, vol. 14, no. 4, Apr. 2014, pp. 849–56. Pubmed, doi:10.1111/ajt.12636.
Snyder LD, Gray AL, Reynolds JM, Arepally GM, Bedoya A, Hartwig MG, Davis RD, Lopes KE, Wegner WE, Chen DF, Palmer SM. Antibody desensitization therapy in highly sensitized lung transplant candidates. Am J Transplant. 2014 Apr;14(4):849–856.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

April 2014

Volume

14

Issue

4

Start / End Page

849 / 856

Location

United States

Related Subject Headings

  • Survival Rate
  • Surgery
  • Risk Factors
  • Prognosis
  • Plasmapheresis
  • Middle Aged
  • Male
  • Lung Transplantation
  • Lung Diseases
  • Isoantibodies