November 18, 2011

How to deal with presensitized candidates for heart transplantation?


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The increased sensitivity of current HLA antibody testing methods, utilization of ventricular assist devices, and application of calculated panel-reactive antibody (cPRA) values has translated into a larger number of sensitized patients awaiting heart transplantation. The current review thoroughly outlines the changes in HLA antibody testing methods, application, and limitations. Important details relating to risk factors for sensitization, clinical management of sensitized patients, as well as current and novel methods for desensitization are also discussed in reasonable detail. Overall this review covers all areas of concern to clinicians dealing with this high-risk patient population. However, the many references to previous studies focusing on definition of populations based on percent PRA can be over-interpreted. It is important to remember that being PRA positive increases your risk for having donor-specific antibodies (DSA) to potential donors, but that PRA does NOT equal DSA.

Cardiac Transplantation

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