The Management of Antibodies in Heart Transplantation: An ISHLT Consensus Document

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Published 4 February 2018

Jon Kobashigawa, MD; Monica Colvin, MD; Luciano Potena, MD, PhD; Duska Dragun, MD; Maria G. Crespo-Leiro, MD, PhD; Juan F. Delgado, MD; Michael Olymbios, MBBS; Jayan Parameshwar, MD; Jignesh Patel, MD, PhD; Elaine Reed, PhD; Nancy Reinsmoen, PhD, D(ABHI); E. Rene Rodriguez, MD; Heather Ross, MD; Randall C. Starling, MD, MPH; Dolly Tyan, PhD; Simon Urschel, MD; Andreas Zuckermann, MD

J Heart Lung Transplant. May 2018;37(5):537-47

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Despite the successes from refined peri-operative management techniques and immunosuppressive therapies, antibodies remain a serious cause of morbidity and mortality for patients both before and after heart transplantation. Patients awaiting transplant who possess antibodies against human leukocyte antigen are disadvantaged by having to wait longer to receive an organ from a suitably matched donor. The number of pre-sensitized patients has been increasing, a trend that is likely due to the increased use of mechanical circulatory support devices. Even patients who are not pre-sensitized can go on to produce donor-specific antibodies after transplant, which are associated with worse outcomes. The difficulty in managing antibodies is uncertainty over which antibodies are of clinical relevance, which patients to treat, and which treatments are most effective and safe. There is a distinct lack of data from prospective trials. 

An international consensus conference endorsed by the International Society for Heart and Lung Transplantation (ISHLT) took place on April 25, 2016, in Washington, DC. 103 participants from 75 centers around the world with extensive clinical and research experience in a broad range of specialties gathered to debate contentious issues, determine the best practices, and formulate ideas for future research on antibodies. Prominent experts presented state-of-the-art talks on antibodies, which were followed by group discussions, and then, finally, a reconvened session to establish consensus where possible.

Read at JHLT

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