Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:15pm-3:27pm
Location: Room 118-C
Purpose: Allosensitization of patients (pts) awaiting heart transplantation is a significant challenge as it prolongs the time to transplant, increases wait-list mortality and increases risk of rejection and allograft vasculopathy after transplant. We have previously reported our initial experience of desensitization with plasmapheresis and bortezomib (PP/BTZ)[JHLT 2011 doi: 10.1016/j.healun.2011.08.009]. We now present an update on an extended cohort.
Methods: Between 2010 and 2014, 30 patients underwent treatment with at least one cycle of PP/BTZ as previously described. Patients underwent evaluation of antibodies prior to treatment and at two weeks post treatment. Adverse effects were documented. For those having proceeded to transplant (22 pts), 1 year (yr) actuarial survival and 1 yr freedom from any treated rejection (ATR) was determined.
Results: Treatment was generally well tolerated. 2 pts developed neuropathy, 2 pts neuropathy with gasterointestinal symptoms, 1 pt rash and 1 pt thrompocytopenia. 1 yr actuarial freedom from infection was 33.3%. 20/26 pts (76.9%) demonstrated a decrease in HLA Class I PRA (mean 19.4 ±22.2%). 15/27 pts (55.6%) demonstrated a decrease in Class II PRA (mean 12.7±13.7%). 15/29 pts (51.7%) demonstrated a decrease in calculated PRA (mean 18.3±19.4%). 5/7 pts(71.8%) with elevated Class I PRA and 6/11 pts (54.5%) with elevated Class II PRA after 1:8 serum dilution demonstrated a decrease (13.8±12.6% and 12.5±7%, respectively). 1/2 pts with C1q+ Class I PRA and 4/9 pts (44.4%) with C1q+ Class II PRA had a decrease (24.0% and 27.0±20.8%, respectively). Of 22 transplanted pts, 1 yr survival was 100%, 1 yr freedom from ATR 73.9%. Freedom from treated cellular and antibody-mediated rejection at 1 yr was 85.2% and 81.8%, respectively.
Conclusion: PP/BTZ was effective at reducing HLA antibody burden in a majority of sensitized pts, including pts with high burden as determined by 1:8 dilution and C1q+ antibodies. The majority of pts were able to undergo transplant with excellent outcomes at 1 yr. Further studies are indicated to determine optimal efficacy and long term outcomes.
To cite this abstract in AMA style:Patel J, Reinsmoen N, Kittleson M, Dilibero D, Liou F, Chang D, Hamilton M, Czer L, Esmailian F, Kobashigawa J. Outcome of Bortezomib/Plasmapheresis for the Sensitized Patient Awaiting Heart Transplant [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/outcome-of-bortezomibplasmapheresis-for-the-sensitized-patient-awaiting-heart-transplant/. Accessed September 16, 2019.
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