2025 HFSA Contemporary Issues in Heart Failure - OnDemand-Approach to Antibodies in Heart Transplantation

Video Transcription

Video Summary

Michelle Kittleson presents an approach to managing antibodies in heart transplantation, focusing on antibody-mediated rejection (AMR). Sensitization to HLA antibodies complicates transplantation by increasing rejection risk. Assessment involves screening for antibodies, identifying their specificity via solid-phase immunoassays, and characterizing their strength and complement-fixing ability to predict cytotoxicity. The calculated panel reactive antibody (CPRA) quantifies transplant compatibility; higher CPRA means fewer suitable donors and worse waitlist outcomes. Desensitization strategies, adapted from kidney transplant protocols, include IVIG, rituximab, plasmapheresis, bortezomib, and newer agents like tocilizumab, targeting B cells and plasma cells to reduce antibody levels. Crossmatching methods guide donor selection: negative flow and CDC crossmatches are ideal; positive CDC crossmatch predicts hyperacute rejection and transplant avoidance; positive flow but negative CDC crossmatch may be managed successfully with eculizumab, a complement inhibitor shown to improve outcomes. Post-transplant, patients require close monitoring and tailored therapies for AMR, balancing prevention, treatment, and maintenance to optimize graft survival.

Keywords

antibody-mediated rejection

HLA antibodies

calculated panel reactive antibody

desensitization strategies

crossmatching methods

eculizumab