Serum dilutions as a predictive biomarker for peri-operative desensitization: An exploratory approach to transplanting sensitized heart candidates

Olga A. Timofeeva, Rene Alvarez, Justin Pelberg, Edward Yoon, Mohamed Alsammak, Steve S. Geier, Christina Ruggia-Check, Jared Hassler, Jamael Hoosain, Meredith A. Brisco, Nana Afari-Armah, Val Rakita, Stacey Brann, Suresh Keshavamurthy, Jesus Gomez-Abraham, Kenji Minakata, Yoshiya Toyoda, Eman Hamad

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Antibody-mediated rejection (AMR) of cardiac allografts mediated by anti-HLA Donor Specific Antibodies (DSA) is one of the major barriers to successful transplantation for the treatment of end-stage heart failure. Therapeutic plasma exchange (TPE) is a first-line treatment for pre-transplant desensitization. However, indications for treatment regimens and treatment end-points have not been well established. In this study, we investigated how sera dilutions could guide TPE regimens for effective peri-operative desensitization and early AMR treatment. Our data show that 1:16 dilutions of EDTA-treated sera and 1.5 volume TPE reduce anti-HLA class I and class II antibody levels in the same manner and, therefore, allows to predict which antibodies would respond to peri-operative TPE. We successfully applied this approach to transplanting three highly sensitized cardiac recipients (CPRA 85–93%) with peri-operative desensitization based on a virtual crossmatch performed on 1:16 diluted serum. Furthermore, we have used sera dilutions to guide DSA treatment post-transplant. Although these findings have to be confirmed in a larger prospective study, our data suggest that serum dilutions can serve as a predictive biomarker to guide peri-operative desensitization and post-transplant immunologic management.

Original languageEnglish
Article number101274
JournalTransplant Immunology
Volume60
DOIs
StatePublished - Jun 2020

Bibliographical note

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

  • Antibody mediated rejection
  • HLA donor specific antibody
  • Heart transplant
  • High CPRA
  • Highly sensitized patients
  • Therapeutic plasma exchange

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Transplantation

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