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. 2021 Jan;35(1):e14146.
doi: 10.1111/ctr.14146. Epub 2020 Nov 23.

Urgent desensitization in patients bridged to heart transplantation under extracorporeal membrane oxygenation support: A preliminary experience

Julien Guihaire  1 , Serena D'Avino  1 , Francois Stephan  2 , Martin Kloeckner  1 , Ngoc Tram To  1 , Agathe Potier  1 , Maïra Gaillard  1 , Ramzi Ramadan  1 , Jean-Luc Taupin  3 , Jerome Le Pavec  4 , Philippe Deleuze  1
Affiliations

Urgent desensitization in patients bridged to heart transplantation under extracorporeal membrane oxygenation support: A preliminary experience

Julien Guihaire et al. Clin Transplant. 2021 Jan.

Abstract

Antihuman leukocyte antigen (HLA) antibodies restrict the access to cardiac allografts. Desensitization therapy is a major challenge in patients with cardiogenic shock waiting for urgent heart transplantation (HT). We retrospectively reviewed six patients (mean age of 37.5 years [16-70]) who underwent plasmapheresis (PP) under extracorporeal membrane oxygenation (ECMO) before transplant between January 2017 and September 2018. The average duration of follow-up was 25 months [20-32]. Mean fluorescence intensity (MFI) of HLA-specific antibodies was reported as follows: score 4 for MFI < 1000, score 6 for 1000 < MFI < 3000 and score 8 for MFI > 3000. The mean duration of ECMO support was 29 days [1-74] and 6.8 [1-29] PP sessions were performed per patient before transplant. The mean number of HLA-specific antibodies before HT was 9.6 for score 6 [4-13] and 5.8 for score 8 [1-12]. Four patients had major complications after transplantation (2 hemorrhagic shocks, 5 infectious events). Mean MFI reduction rate was 94% [79-100] for Class I and 44.2% for Class II [0-83]. Hospital survival was 100%, and early antibody-mediated rejection was diagnosed in one patient at 7 days after HT. Plasmapheresis under ECMO support was associated with favorable early outcomes in highly sensitized candidates for urgent heart transplantation.

Keywords: extracorporeal membrane oxygenation; heart transplantation; plasmapheresis; sensitization.

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References

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