Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation. Export

@article{citeulike:1712291, abstract = {BACKGROUND: Patients with a PRA >10\% are considered to be at greater risk for the development of not only acute cellular and humoral rejection but also increased mortality when compared to nonsensitized patients following transplantation. All patients with a PRA >10\% at our institution are treated with plasmapheresis and intravenous immunoglobulin G immediately prior to cardiac transplantation. METHODS: Sixteen (Group 1) of 118 patients awaiting cardiac transplantation were found to be sensitized. These patients underwent plasmapheresis followed by 20 gm of intravenous immunoglobulin G (IVIG) immediately prior to cardiac transplantation. Group 1 was compared to the remaining 102 patients with a PRA <10\% (Group 2). RESULTS: Despite more patients in Group 1 having a positive crossmatch, pulmonary hypertension, and requiring mechanical circulatory support, there was no statistically significant difference in length of stay or mortality at a mean follow-up of 21.6+/-15.0 months. There was no difference in the occurrence of mild, moderate or severe cellular rejection or humoral rejection in these sensitized patients when compared to Group 2. CONCLUSIONS: Pretransplant plasmapheresis followed by intravenous immunoglobulin G may be an effective therapy that obviates the need for a prospective crossmatch and allows sensitized patients to undergo cardiac transplantation. There is no increase in the post transplant length of stay, occurrence of rejection or short term mortality. Long term follow up is necessary to evaluate whether there is a difference in the development of late rejection, transplant vasculopathy and survival.}, address = {Department of Cardiology, Loyola University of Chicago at the Medical Center, Maywood, Illinois 60153, USA.}, author = {Pisani, B. A. and Mullen, G. M. and Malinowska, K. and Lawless, C. E. and Mendez, J. and Silver, M. A. and Radvany, R. and Robinson, J. A.}, citeulike-article-id = {1712291}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/10452347}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=10452347}, issn = {1053-2498}, journal = {J Heart Lung Transplant}, keywords = {amr, hla, sensitized, transplantation}, month = {July}, number = {7}, pages = {701--706}, posted-at = {2007-09-30 21:31:08}, priority = {2}, title = {Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/10452347}, volume = {18}, year = {1999} }

TY - JOUR ID - citeulike:1712291 L3 - citeulike-article-id:1712291 N2 - BACKGROUND: Patients with a PRA >10% are considered to be at greater risk for the development of not only acute cellular and humoral rejection but also increased mortality when compared to nonsensitized patients following transplantation. All patients with a PRA >10% at our institution are treated with plasmapheresis and intravenous immunoglobulin G immediately prior to cardiac transplantation. METHODS: Sixteen (Group 1) of 118 patients awaiting cardiac transplantation were found to be sensitized. These patients underwent plasmapheresis followed by 20 gm of intravenous immunoglobulin G (IVIG) immediately prior to cardiac transplantation. Group 1 was compared to the remaining 102 patients with a PRA <10% (Group 2). RESULTS: Despite more patients in Group 1 having a positive crossmatch, pulmonary hypertension, and requiring mechanical circulatory support, there was no statistically significant difference in length of stay or mortality at a mean follow-up of 21.6+/-15.0 months. There was no difference in the occurrence of mild, moderate or severe cellular rejection or humoral rejection in these sensitized patients when compared to Group 2. CONCLUSIONS: Pretransplant plasmapheresis followed by intravenous immunoglobulin G may be an effective therapy that obviates the need for a prospective crossmatch and allows sensitized patients to undergo cardiac transplantation. There is no increase in the post transplant length of stay, occurrence of rejection or short term mortality. Long term follow up is necessary to evaluate whether there is a difference in the development of late rejection, transplant vasculopathy and survival. IS - 7 JF - J Heart Lung Transplant SN - 1053-2498 AD - Department of Cardiology, Loyola University of Chicago at the Medical Center, Maywood, Illinois 60153, USA. EP - 706 TI - Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation. VL - 18 SP - 701 KW - amr KW - hla KW - sensitized KW - transplantation AU - Pisani, BA AU - Mullen, GM AU - Malinowska, K AU - Lawless, CE AU - Mendez, J AU - Silver, MA AU - Radvany, R AU - Robinson, JA PY - 1999/07// UR - http://view.ncbi.nlm.nih.gov/pubmed/10452347 ER -