CASE REPORT: PRE-TRANSPLANT TESTING AND POST-TRANSPLANT MONITORING FOR AN HLA-IMMUNIZED RECIPIENT IN HEART TRANSPLANTATION

Lucija Jukic; Biserka Palfi; Bosko Skoric; Marija Burek Kamenaric

doi:10.33602/mebm.3.1.9

Lucija Jukic Tissue Typing Centre, Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
Biserka Palfi Tissue Typing Centre, Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb
Bosko Skoric Department for Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Zagreb, Croatia
Marija Burek Kamenaric Tissue Typing Centre, Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb

DOI: https://doi.org/10.33602/mebm.3.1.9

Keywords: immunogenetics, HLA antibodies, sensitization, DSA monitoring, heart transplantation

Abstract

We report the workflow of immunogenetic pre-transplant testing and post-transplant monitoring in the case of a recipient immunized to human leucocyte antigens (HLA) who was waitlisted for heart transplantation. The recipient underwent heart transplantation across preformed HLA class I Donor Specific Antibodies (DSAs) detected by solid phase Luminex screening method but not by complement dependent cytotoxicity (CDC) screening method. The CDC lymphocyte crossmatch, which was performed retrospectively, was a weak positive. Post-transplant DSA monitoring by Luminex method revealed the decrease of HLA-A1, A25 and B57 DSAs with, at the same time, an increase of HLA-B8 DSA, as well as weak transient non-DSA HLA-DP antibodies. This case presents the importance of extensive immunogenetic testing and monitoring for identifying recipients with increased immunological risk for successful heart transplantation.