Antibody Mediated Rejection in Heart Transplantation
Antibody Mediated Rejection in Heart Transplantation
Antibody Mediated Rejection in Heart Transplantation
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Desensitization Protocols<br />
• Adapted from renal transplantation experience<br />
• Indications<br />
– Pre-transplant cPRA > 50% to prevent AMR<br />
– Post-transplant<br />
• Positive Xmatch (<strong>in</strong>duction)<br />
• Refractory AMR<br />
• Components<br />
– Remove preformed Ab: Plasmapheresis<br />
– Block Ab function: IV IgG<br />
– B cell destruction: Monoclonal Ab aga<strong>in</strong>st<br />
CD20 on B cells – Rituximab<br />
– Plasma cell destruction: Proteasome<br />
<strong>in</strong>hibitor target<strong>in</strong>g plasma cells – Bortezomib<br />
• FDA approved for multiple myeloma
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