Antibody Mediated Rejection in Heart Transplantation
Antibody Mediated Rejection in Heart Transplantation
Antibody Mediated Rejection in Heart Transplantation
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Cellular<br />
<strong>Antibody</strong>-<strong>Mediated</strong><br />
Asymptomatic/<br />
Subcl<strong>in</strong>ical<br />
• Target higher<br />
CNI levels<br />
• Oral steroid<br />
bolus + taper<br />
• Sirolimus<br />
To treat or not<br />
to treat ?<br />
Treatment of <strong>Rejection</strong><br />
Reduced EF<br />
• Oral steroid bolus/<br />
taper<br />
or<br />
• IV pulse steroids<br />
• IV pulse steroids<br />
or<br />
• Cytolytic therapy<br />
• Plasmapheresis<br />
(before ATG dose)<br />
• IV immune globul<strong>in</strong><br />
<strong>Heart</strong> Failure/Shock<br />
• IV pulse steroids<br />
• Cytolytic therapy<br />
(ATG)<br />
• Plasmapheresis<br />
( before ATG dose)<br />
• IV immune globul<strong>in</strong><br />
• Inotropic therapy<br />
• IV hepar<strong>in</strong><br />
• Inotropes, IABP<br />
or ECMO support
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