Hyperacute graft dysfunction in an orthotopic heart transplant in the presence of non-HLA antibodies.

Szczegóły
Abstrakt

Tytuł:: Hyperacute graft dysfunction in an orthotopic heart transplant in the presence of non-HLA antibodies.
Autorzy:: Villa C; HLA Lab, Vitalant, Spokane, Washington.
Mesa K; Mechanical Heart Program, Providence Sacred Heart Medical Center & Children's Hospital, Spokane, Washington.
Cristy Smith M; Center for Advanced Heart Disease and Transplantation, Providence Sacred Heart Medical Center & Children's Hospital, Spokane, Washington.
Mooney DM; Center for Advanced Heart Disease and Transplantation, Providence Sacred Heart Medical Center & Children's Hospital, Spokane, Washington.
Coletti A; Center for Advanced Heart Disease and Transplantation, Providence Sacred Heart Medical Center & Children's Hospital, Spokane, Washington.
Klohe E; HLA Lab, Vitalant, Spokane, Washington.
Źródło:: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2020 Feb; Vol. 20 (2), pp. 593-599. Date of Electronic Publication: 2019 Sep 09.
Typ publikacji:: Case Reports; Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 2023- : [New York] : Elsevier
Original Publication: Copenhagen : Munksgaard International Publishers, 2001-
MeSH Terms:: Heart Transplantation*
Graft Rejection/*etiology
Receptor, Angiotensin, Type 1/*agonists
Adult ; Aged ; Blood Grouping and Crossmatching ; Extracorporeal Membrane Oxygenation ; Graft Rejection/immunology ; HLA Antigens/immunology ; Histocompatibility Testing ; Humans ; Male ; Primary Graft Dysfunction/etiology ; Receptor, Angiotensin, Type 1/immunology
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Contributed Indexing:: Keywords: autoantibody; clinical research/practice; health services and outcomes research; heart transplantation/cardiology; patient characteristics; patient survival; rejection; risk assessment/risk stratification
Substance Nomenclature:: 0 (HLA Antigens)
0 (Receptor, Angiotensin, Type 1)
Entry Date(s):: Date Created: 20190811 Date Completed: 20210219 Latest Revision: 20230124
Update Code:: 20240104
DOI:: 10.1111/ajt.15564
PMID:: 31400258
: Czasopismo naukowe

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Antibody-mediated rejection (AMR) in heart transplants in the absence of anti-HLA donor-specific antibody (DSA) is not well studied or documented. This case reviews hyperacute fulminant graft dysfunction suspected to be mediated by non-HLA antibodies. After cross clamp removal, the patient developed severe pulmonary edema, profound coagulopathy, and biventricular failure. The patient's presumed AMR, cardiogenic shock, and coagulopathy were treated with extracorporeal membrane oxygenation (ECMO), plasmapheresis, intravenous immunoglobulin (IVIG), multiple blood products, and prothrombin complex concentrate. The recipient was 0% panel-reactive antibody (PRA), ABO, and crossmatch compatible. Intraoperative biopsy sample revealed a thrombotic process suggestive of a coagulation pathway activated by AMR; however, no C4d deposition was detected. Postmortem biopsies also suggested AMR. Retrospective testing of the patient's pretransplant serum revealed strong antiangiotensin II type 1 receptor (AT1R) antibodies and a strongly positive endothelial cell crossmatch. Anti-AT1R antibodies are known to be AT1 receptor agonists and may trigger inflammation and activate the extrinsic coagulation pathway. Given the potential effects of signaling through the AT1R, the patient's preexisting anti-AT1R antibodies and procoagulant therapy may have adversely affected the patient's clinical course.
(© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)

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