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Question:
What are the protocols to lower antibodies for heart transplantation?
Are there any protocols that your center uses to lower antibodies for heart transplant? When I became ill I was at 2 percent. Due to blood transfusions and being on the VAD machine, they were up to 96 percent but are now at about 89. The protocol that I have been through twice was plasmapheresis for 5 days, then 2 days of IVIG, 1 day of Retuxin, and then another day of Retuxin and then 2 days of IVID ... over a 44 day period. I am almost done with the 2nd round and so far this round has not brought them down at all. Is there anything else that can be tried? Can a person be transplanted with that percentage of antibodies?
submitted by Jolynn, from Arizona, on 11/8/09
Answer:
by Texas Heart Institute cardiovascular surgeon, William E. Cohn, MD
Hi Jolynn. It sounds like your doctors are doing all the things that we would do at the Texas Heart Institute. Although it is not absolutely clear, it seems pretty convincing that patients with high levels of pre-reactive antibodies (PRA) experience a greater risk of rejection after heart transplantation than those with low levels of PRA. That said we have had success with heart transplantation in patients with PRAs in the high 90s.
There are new drugs on the horizon which show promise. One that is supposed to enter clinical trials in the coming year is Velcade, a drug that decreases the number of plasma cells, and in so doing, decreases PRA. If it works like many think it will, it may be a valuable drug to decrease the risk of heart transplantation in patients like you. Good luck.
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Updated November 2009
