Sensitization in Heart Transplantation: Emerging Knowledge: A Scientific Statement From the American Heart Association

Circulation. 2019 Mar 19;139(12):e553-e578. doi: 10.1161/CIR.0000000000000598.

Abstract

Sensitization, defined as the presence of circulating antibodies, presents challenges for heart transplant recipients and physicians. When present, sensitization can limit a transplantation candidate's access to organs, prolong wait time, and, in some cases, exclude the candidate from heart transplantation altogether. The management of sensitization is not yet standardized, and current therapies have not yielded consistent results. Although current strategies involve antibody suppression and removal with intravenous immunoglobulin, plasmapheresis, and antibody therapy, newer strategies with more specific targets are being investigated.

Keywords: AHA Scientific Statements; antibodies; heart transplantation; human leukocyte antigen.

MeSH terms

  • Graft Rejection / etiology
  • Graft Rejection / prevention & control*
  • HLA Antigens / immunology
  • Heart Transplantation* / adverse effects
  • Histocompatibility Testing
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Isoantibodies / blood
  • Isoantibodies / immunology
  • Plasma Exchange
  • Plasmapheresis
  • Rituximab / therapeutic use

Substances

  • HLA Antigens
  • Immunoglobulins, Intravenous
  • Isoantibodies
  • Rituximab