Abstract
Approximately 30% of patients on transplantation waiting lists are sensitized to HLA
antigens as a result of previous exposure through prior transplants, pregnancies or blood
transfusions. Besides increasing the waiting time on the list, sensitization to HLA
antigens is a major immunologic barrier to solid organ transplantation. Indeed, without
proper immunosuppressive strategies, sensitized patients are at high risk of antibodymediated
rejection (AMR) and graft loss. Over the past years, several centers have
developed desensitization and immunomodulatory approaches that result in reduction of
anti-HLA antibodies with improved rates of successful transplantation.
The aim of the current work was to review current therapeutic practice for sensitized
patients awaiting a solid organ transplant. In particular, we were interested in
summarizing current data regarding the management of sensitized patients awaiting a
heart transplant. To illustrate the topic, we first studied in detail two complex clinical
cases. We then performed a systematic review of current literature in the field (since
1997) regarding current immunomodulatory approaches to treat anti-HLA antibodies
before transplantation, focusing on cardiac transplantation.
To date, there is no approved therapeutic protocol or consensus on the management
of sensitized patients and anti-HLA antibodies before solid organ transplantation. The
data are even scarcer regarding thoracic organ transplantation. This study that reviewed
current practice may help define best possible approaches for these patients before and
after transplantation to ensure better outcomes.