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Review
. 2019 Oct;8(4):302-313.
doi: 10.21037/tp.2019.07.13.

Management of the sensitized pediatric heart transplant patient

Erik L Frandsen  1 , Erin L Albers  1
Affiliations
Review

Management of the sensitized pediatric heart transplant patient

Erik L Frandsen et al. Transl Pediatr. 2019 Oct.

Abstract

Despite advancements in transplant immunosuppression and techniques for managing critically ill patients awaiting heart transplantation, children who are immunologically sensitized to human leukocyte antigen remain at increased risk for morbidity and mortality, both while awaiting and after heart transplant. In this review we will discuss the epidemiology of sensitization, review the immunologic basis and methods of human leukocyte antigen antibody detection, describe outcomes for sensitized pediatric transplant candidates, and consider both pre- and post-transplant management options for sensitized patients.

Keywords: Pediatric; antibodies; heart transplantation; human leukocyte antigen (HLA); sensitization.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Proposed algorithm for management of sensitized patients before, at, and after transplant. Mod, moderate; PRA, panel reactive antibody; cPRA, calculated PRA; HLA, human leukocyte antigen; Ab, antibody; POD, postoperative day; ATG, anti-thymocyte globulin; mos, months; IVIG, intravenous immunoglobulin; ECHO, echocardiogram; ECG, electrocardiogram; MCS, mechanical circulatory support; UA, unacceptable antigen; PRBC/plt, packed red blood cell/platelet; CPB, cardiopulmonary bypass; XM, crossmatch; DSA, donor-specific antibody; CVL, central venous line; AMR, antibody-mediated rejection.
Figure 2
Figure 2
Sites of action of various desensitization/AMR therapies. NK, natural killer cell; ATG, anti-thymocyte globulin; MMF, mycophenolic acid mofetil; IVIG, intravenous immunoglobulin; MAC, membrane attack complex; HLA, human leukocyte antigen; DSA, donor-specific antibody.
See this image and copyright information in PMC

References

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