Issue |
J Extra Corpor Technol
Volume 31, Number 4, December 1999
|
|
---|---|---|
Page(s) | 177 - 183 | |
DOI | https://doi.org/10.1051/ject/1999314177 | |
Published online | 14 August 2023 |
Original Article
Plasmapheresis During Cardiopulmonary Bypass: A Proposed Treatment For Presensitized Cardiac Transplantation Patients
Sarver University Heart Center, Circulatory Sciences Graduate Perfusion Program, University of Arizona, Tucson, Arizona
* Address correspondence to: Douglas F. Larson, PhD, CCP Sarver University Heart Center Circulatory Sciences Graduate Perfusion Program University of Arizona Tucson, AZ 85724
Potential thoracic organ transplantation recipients who have positive cytotoxic antibody screens as quantified panel reactive antibodies (PRA) are at risk for immediate or long-term immunologic events that may affect the donor organ. The patient population at risk includes those who are supported with cardiac assist devices, multiparous women, and individuals receiving numerous homologous blood products. We treated three highly positive PRA patients with intraoperative plasmapheresis coupled to the cardiopulmonary bypass system to remove sufficient cytotoxic antibody. Upon the availability of donor hearts of an unknown HLA type, intraoperative plasmapheresis was performed using a Cobe Spectra Plasmapheresis system coupled to a Terumo CXSX18 oxygenator system. Three plasma volume exchanges of fresh frozen plasma (FFP) were performed while the patients were on cardiopulmonary bypass. One to one and one-half plasma volume exchange plasmaphereses were performed with a declining schedule for the next 30 days post-transplantation in combination with aggressive B-cell specific immunosuppressive therapy. The three patients are NYHA functional class I and free of rejection at 6 months post-transplantation. In conclusion, intraoperative plasmapheresis is effective and safe for the patient who would not be otherwise transplanted because of markedly elevated PRAs.
Key words: plasmapheresis / panel reactive antibody / cardiopulmonary bypass / cardiac transplantation
© 1999 AMSECT
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