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

Antonietta Picascia, Vincenzo Grimaldi, Amelia Casamassimi, Maria Rosaria De Pascale, Concetta Schiano, Claudio Napoli

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)664-675
Number of pages12
JournalJournal of Cardiovascular Translational Research
Volume7
Issue number7
DOIs
Publication statusPublished - Oct 4 2014

Keywords

  • Anti-HLA antibodies
  • Antibody-mediated rejection
  • Cardiac allograft vasculopathy
  • Desensitization therapy
  • Heart transplantation
  • Solid-phase assays
  • Ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Genetics
  • Genetics(clinical)
  • Molecular Medicine
  • Pharmaceutical Science
  • Medicine(all)

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