• Hsun-Yi Fu, Yi-Chia Wang, Chuan-I Tsao, Sz-Han Yu, Yih-Sharng Chen, Heng-Wen Chou, Nai-Hsin Chi, Chih-Hsien Wang, Ron-Bin Hsu, Shu-Chien Huang, Hsi-Yu Yu, and Nai-Kuan Chou.
• Department of Cardiac Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
• J Formos Med Assoc. 2022 May 1; 121 (5): 969-977.

Background/PurposeSensitization, the presence of preformed anti-human antibody in recipients, restricts access to ABO-compatible donors in heart transplant. Desensitization therapy works by reducing preformed antibodies to increase the chances of a negative crossmatch or permit safe transplantation across positive crossmatch. There is no consensus regarding the desensitization protocol in cardiac patients, and the outcome of desensitization remains under debate.MethodsTwenty-five consecutive sensitized heart transplant recipients received perioperative desensitization in our institution from 2012 to 2019. One-year patient survival and graft rejection rate were analyzed and compared between sensitized recipients and non-sensitized recipients.ResultsWithin the first year after transplant, patient survival in sensitized recipients was 76%. Infection was the major cause of death. The cumulative incidence of rejection was 8% for antibody-mediated rejection and 16% for acute cellular rejection. No significant difference in 1-year survival or rejection rate could be demonstrated between sensitized and nonsensitized recipients.ConclusionAcceptable early outcomes in patient survival and graft rejection could be anticipated in sensitized heart transplant recipients under a perioperative algorithm using complement-dependent cytotoxicity crossmatch- or panel-reactive antibody-directed urgent immunomodulation strategies, while infection remains the major concern.Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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