التفاصيل البيبلوغرافية
| العنوان: |
Rapid desensitization through immunoadsorption during cardiopulmonary bypass. A novel method to facilitate human leukocyte antigen incompatible heart transplantation. |
| المؤلفون: |
Issitt, Richard W, Cudworth, Eamonn, Cortina-Borja, Mario, Gupta, Arun, Kallon, Delordson, Crook, Richard, Shaw, Michael, Robertson, Alex, Tsang, Victor T, Henwood, Sophie, Muthurangu, Vivek, Sebire, Neil J, Burch, Michael, Fenton, Matthew |
| المصدر: |
Perfusion; Apr2024, Vol. 39 Issue 3, p543-554, 12p |
| مصطلحات موضوعية: |
FLOW cytometry, T cells, RESEARCH funding, CARDIOPULMONARY bypass, EVALUATION of medical care, DESCRIPTIVE statistics, HEART transplantation, PEDIATRICS, ALLERGY desensitization, IMMUNOADSORPTION, BLOOD grouping & crossmatching, DATA analysis software, HLA-B27 antigen, ALLELES |
| مستخلص: |
Background: Anti-human leukocyte antigen (HLA)-antibody production represents a major barrier to heart transplantation, limiting recipient compatibility with potential donors and increasing the risk of complications with poor waiting-list outcomes. Currently there is no consensus to when desensitization should take place, and through what mechanism, meaning that sensitized patients must wait for a compatible donor for many months, if not years. We aimed to determine if intraoperative immunoadsorption could provide a potential desensitization methodology. Methods: Anti-HLA antibody-containing whole blood was added to a Cardiopulmonary bypass (CPB) circuit set up to mimic a 20 kg patient undergoing heart transplantation. Plasma was separated and diverted to a standalone, secondary immunoadsorption system, with antibody-depleted plasma returned to the CPB circuit. Samples for anti-HLA antibody definition were taken at baseline, when combined with the CPB prime (on bypass), and then every 20 min for the duration of treatment (total 180 min). Results: A reduction in individual allele median fluorescence intensity (MFI) to below clinically relevant levels (<1000 MFI), and in the majority of cases below the lower positive detection limit (<500 MFI), even in alleles with a baseline MFI >4000 was demonstrated. Reduction occurred in all cases within 120 min, demonstrating efficacy in a time period usual for heart transplantation. Flowcytometric crossmatching of suitable pseudo-donor lymphocytes demonstrated a change from T cell and B cell positive channel shifts to negative, demonstrating a reduction in binding capacity. Conclusions: Intraoperative immunoadsorption in an ex vivo setting demonstrates clinically relevant reductions in anti-HLA antibodies within the normal timeframe for heart transplantation. This method represents a potential desensitization technique that could enable sensitized children to accept a donor organ earlier, even in the presence of donor-specific anti-HLA antibodies. [ABSTRACT FROM AUTHOR] |
|
Copyright of Perfusion is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder