Current Topics in TransplantationThoracic transplantationSafety and Efficacy of Immunoadsorption in Heart Transplantation Program

- Immunoadsorption can be used for the treatment of immunized patients before heart transplantation (HTX) and as the first step of antibody-mediated rejection treatment after HTX is performed
- A comparison of values before immunoadsorption and after the last procedure showed a decrease in immunoglobulin levels
- Immunoadsorption in patients during HTX is a safe procedure, reducing donor-specific antibodies

BackgroundAntibody-mediated rejection (AMR) is a serious complication of organ transplantation, and its treatment is complex. The aim of this study was to assess immunoadsorption (IA) for treatment-immunized patients before heart transplantation (HTX) and as the first step of AMR treatment after HTX.MethodsThe cohort consisted of 10 patients (8 men, 2 women; age range, 20-57 years). For 3 of these patients, IA was included in the desensitization protocol before HTX; for 7 patients, IA was the first step of the treatment protocol. One patient underwent IA before and after HTX.ResultsA comparison of values before IA and after the last procedure showed a decrease in immunoglobulin subgroups (G, M, and A). In patients before HTX, a decline was noted in panel reactive antibodies. After HTX, IA procedures led to a significant decrease in donor-specific antibody (DSA) class I; DSA class II fell in 6 of 7 patients, with 51% falling below the detection limit.ConclusionsIA in patients during HTX is safe procedure for reducing DSA. The removal of antibodies is the first step in comprehensive treatment and must be followed by a procedure that prevents their further development.