*Purpose: As many patients with severe heart disease require mechanical circulatory support (MCS), the number of sensitized patients developing circulating antibodies continues to rise. In many programs, up to 30% of patients are considered “sensitized.” Some of these patients who are more highly sensitized require desensitization prior to receiving a donor heart. Desensitization strategies include IVIG/rituximab, bortezomib, and plasmapheresis. 5-year outcomes for these desensitized patients have not been established.

*Methods: Between 2007 and 2013, we assessed 34 sensitized patients who underwent desensitization prior to heart transplantation (HTx). Desensitization strategies included IVIG/rituximab (n=11), bortezomib/plasmapheresis (n=12), or a combination of these therapies (n=11). These patients were followed post-transplant for five years and analyzed for the following endpoints: survival, CAV (as defined by stenosis ≥ 30% by angiography), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and freedom from any-treated rejection (ATR), acute cellular rejection (ACR), and antibody-mediated rejection (AMR). These patients were compared to a non-desensitized control group without circulating antibodies pre-transplant (n=209).

*Results: For the desensitized patients, 5-year survival, 5-year freedom from CAV, NF-MACE, ATR, and ACR were similar to the control. There was a significantly reduced 5-year freedom from AMR in patients treated with bortezomib/plasmapheresis (see table).

*Conclusions: Patients who are desensitized pre-transplant with bortezomib appear to have more AMR post-transplant but have comparable long-term outcome. Overall, pre-transplant desensitized patients have acceptable outcome post-transplant.

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