@article {232,
	title = {Heart transplantation across antibodies against human leukocyte antigen and ABO-post-transplant follow-up of donor reactive antibodies},
	journal = {Xenotransplantation},
	volume = {13},
	year = {2006},
	note = {Bucin, Dragan Johansson, Sune Lindberg, Lars O Case Reports Denmark Xenotransplantation Xenotransplantation. 2006 Mar;13(2):101-4.},
	month = {Mar},
	pages = {101 - 4},
	edition = {38828},
	abstract = {BACKGROUND: We have successfully performed heart transplantation despite the most unfavourable risk factors for graft and patient survival: the presence of a high level of antibodies (Abs) against the donor{\textquoteright}s human leukocyte antigens (HLA) class I/II and blood group A1 antigens. The present study concerns post-transplant follow-up and characterization of donor reactive antibodies (DRA). METHODS: Pre-transplant treatment consisted of mycophenolate mofetil (MMF), prednisolone, tacrolimus, intravenous immunoglobulin (IVIG), rituximab, protein-A immunoadsorption (PAIA) and per-operative plasma exchange. A standard triple-drug immunosuppressive protocol was used post-operatively. Abs were analyzed by the complement dependent cytotoxicity (CDC) test against donor and panel B/T cells and by flow cytometry (FlowPRA tests detecting isolated HLA class I/II antigens). Abs against the donor{\textquoteright}s erythrocytes were analyzed using a standard direct agglutination test for immunoglobulin M (IgM) Abs and a Bio-Rad AHG gel card test detecting IgG Abs and C3d. RESULTS: Pre-transplant treatment reduced Ab titers against the donor{\textquoteright}s lymphocytes from 128 to 16 and against the donor{\textquoteright}s blood group A1 antigen from 256 to 0. The patient was emergently transplanted with a heart from a blood group incompatible donor (A1 secretor to O). No hyperacute rejection was seen. DRA were present against all mismatched HLA class I and class II antigens at the time of transplantation; two of these DRA Abs disappeared within the first year post-transplant (anti-B62 and anti-DR4), one showed weakened reactivity (anti-A24) and one is still strongly reactive (anti-DQ3). The donor-specific CDC cross-match is still positive (titers 2 to 8). The level of panel reactive antibodies (PRA) remained unchanged from 6 months on post-transplant. Rising anti-A1 blood group Abs preceded the second rejection and were adsorbed by two blood group specific immunoadsorptions (Glycosorb)-ABO) and remained at a low level. IgM anti-A1 blood group Abs disappeared at 1 yr post-transplant and IgG Abs are still reactive with blood group A1 erythrocytes but at low titers (1 to 2). CONCLUSIONS: The patient is clinically well 2 years after heart transplantation despite the constant persistence of donor reactive IgG Abs against blood group A1 and HLA-DQ antigens. The reactivity of DRA against other mismatched HLA antigens disappeared or weakened during the follow-up period.},
	keywords = {ABO Blood-Group System / *immunology, Antibodies / *immunology, Child, Preschool, Female, Follow-Up Studies, Heart Transplantation / *immunology / pathology, HLA Antigens / *immunology, Humans, Tissue Donors},
	issn = {0908-665X (Print) 0908-665X (Linking)},
	doi = {XEN276 [pii] 10.1111/j.1399-3089.2006.00276.x},
	author = {Bucin,D. and Johansson,S. and Lindberg,L. O.}
}
