LAUSR

Purpose Desensitization therapy through reducing preformed antibody to increase the chances of a negative cross-match or permit safe transplantation across positive crossmatch. There was no consensus regarding desensitization protocol in cardiac patients, and the outcome of desensitization in sensitized recipient was still under debate. Methods Consecutive 25 sensitized heart transplant recipients received peri-operative desensitization in our institution from 2012 to 2019. One-year survival and graft rejection rate were analyzed and compared between sensitized recipients and non-sensitized recipients in our institution. Results One-year survival after transplant was 76% in sensitized recipients. Infection was the major cause of death. Incidence of rejection in the first year after transplant was 8% for antibody-mediated rejection and 16% for acute cellular rejection. Compared with the outcome in non-sensitized recipients, no significant difference in 1-year survival or rejection rate (sensitized vs. non-sensitized, survival 76 vs. 84.6%, P = 0.32; antibody-mediated rejection rate 8 vs. 3.1%, P = 0.41; acute cellular rejection rate 16 vs. 6.2% P = 0.20) could be demonstrated. Conclusion Acceptable early outcomes in patient's survival and graft rejection could be anticipated in sensitized heart transplant recipients under a perioperative algorithm using complement-dependent cytotoxicity (CDC) crossmatch - or panel reactive antibody (PRA) - directed urgent immunomodulation strategies, while infection remains the major concern.