Cedars-Sinai Heart Institute, Los Angeles, California 90048, USA.
Curr Opin Organ Transplant. 2012 Aug;17(4):423-6. doi: 10.1097/MOT.0b013e328355f195.
Alloantibodies to human leukocyte antigens (HLAs) in patients awaiting heart transplantation are associated with prolonged wait time to transplant, increased risk of posttransplant rejection and cardiac allograft vasculopathy, and decreased survival. Solid-phase assays to determine antibody presence have allowed for the development of a calculated panel-reactive antibody to denote unacceptable antigens. The virtual crossmatch allows for the comparison of recipient HLA antibodies to prospective donor HLA antigens to safely match a patient to an appropriate donor without a prospective crossmatch.
Expansion of the donor pool and decreased waiting time for heart transplant may be impacted by further assessment of the functional status of alloantibodies and novel means for desensitization. Sensitized patients who receive left ventricular assist device (LVAD) as a bridge to cardiac transplant appear to have similar postoperative 1-year outcomes compared with nonsensitized patients.
Antibody sensitization poses an additional hurdle to patients awaiting heart transplantation. Functional antibody assessment, placement of a LVAD as bridge to cardiac transplant, and novel means of desensitization may impact a sensitized patient's ability to safely undergo heart transplantation.
在等待心脏移植的患者中，针对人类白细胞抗原（HLA）的同种抗体与移植等待时间延长、移植后排斥反应和心脏移植物血管病风险增加以及生存率降低有关。固相检测法可用于确定抗体的存在，从而开发出计算性的群体反应性抗体，以表示不可接受的抗原。虚拟交叉配型允许比较受者 HLA 抗体与预期供者 HLA 抗原，以便在不进行前瞻性交叉配型的情况下安全地将患者与合适的供者相匹配。
进一步评估同种异体抗体的功能状态和新的脱敏方法可能会影响供体库的扩大和心脏移植的等待时间缩短。作为心脏移植桥接的左心室辅助装置（LVAD）接受治疗的致敏患者与非致敏患者相比，术后 1 年的结局相似。
抗体致敏给等待心脏移植的患者带来了额外的障碍。功能性抗体评估、作为心脏移植桥接的 LVAD 放置和新的脱敏方法可能会影响致敏患者安全进行心脏移植的能力。
