Human Leukocyte Antigens and Alloimmunization in Heart Transplantation: An Open Debate

Considerable advances in heart transplantation outcome have been achieved through the improvement of donor-recipient selection, better organ preservation, lower rates of perioperative mortality and the use of innovative immunosuppressive protocols. Nevertheless, long-term survival is still influence...

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Bibliographic Details
Published in:Journal of cardiovascular translational research 2014-10, Vol.7 (7), p.664-675
Main Authors: Picascia, Antonietta, Grimaldi, Vincenzo, Casamassimi, Amelia, De Pascale, Maria Rosaria, Schiano, Concetta, Napoli, Claudio
Format: Article
Language:English
Subjects:
Biomedical Engineering and Bioengineering
Biomedicine
Cardiology
Graft Rejection - immunology
Graft Rejection - mortality
Graft Rejection - prevention & control
Graft Survival
Heart Transplantation - adverse effects
Heart Transplantation - mortality
Histocompatibility
Histocompatibility Testing
HLA Antigens - immunology
Human Genetics
Humans
Immunosuppressive Agents - therapeutic use
Isoantibodies - blood
Medicine
Medicine & Public Health
Predictive Value of Tests
Risk Factors
Transplantation Conditioning - methods
Treatment Outcome
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Summary:Considerable advances in heart transplantation outcome have been achieved through the improvement of donor-recipient selection, better organ preservation, lower rates of perioperative mortality and the use of innovative immunosuppressive protocols. Nevertheless, long-term survival is still influenced by late complications. We support the introduction of HLA matching as an additional criterion in the heart allocation. Indeed, allosensitization is an important factor affecting heart transplantation and the presence of anti-HLA antibodies causes an increased risk of antibody-mediated rejection and graft failure. On the other hand, the rate of heart-immunized patients awaiting transplantation is steadily increasing due to the limited availability of organs and an increased use of ventricular assist devices. Significant benefits may result from virtual crossmatch approach that prevents transplantation in the presence of unacceptable donor antigens. A combination of both virtual crossmatch and a tailored desensitization therapy could be a good compromise for a favorable outcome in highly sensitized patients. Here, we discuss the unresolved issue on the clinical immunology of heart transplantation.
ISSN:1937-5387
1937-5395
DOI:10.1007/s12265-014-9587-z