所属 医学部 医学科（東京女子医科大学病院） 職種 教授
|発表タイトル||Optimization of Histocompatibility Tests for the Heart Transplantation in Japan|
|発表者・共同発表者||◎服部英敏, 菊池規子, 市原有起, 駒ヶ嶺正英, 鈴木敦, 西中知博, 志賀剛, 齋藤聡, 萩原誠久, 新浪博, 布田伸一|
|概要||*Poster Session (Japanese)120 Transplantation/LVAD/Infection
Background: In Japan, histocompatibility test for heart transplant candidates are determined using only complement-dependent cytotoxic crossmatch (CDC-XM) test. Long-term use of ventricular assist device (VAD) can lead to complications such as bleeding, infection, and introduction of heterologous antigens that result in the production of various antibodies. These new antibodies are often CDC-XM positive, rendering patients unable to undergo heart transplantation (HTx). Methods & Results: All patients aged ≥18 years who were listed for HTx between 1998 and 2017 at our institution were retrospectively analyzed. Of 87 patients, two patients showed consecutive CDC-XM positive with the flow cytometry crossmatch (FCXM) negative and undetectable panel reactive antibodies (PRA). 21-year-old man with VAD for 3 years showed 7 consecutive positive CDC-XM since listed on a higher rank. Another 62-year-old man with VAD for 4 years revealed 14 positive CDC-XM with FCXM negative since listed on a higher rank. They could not undergo HTx and required plasmapheresis to eliminate non-HLA IgM antibody, which was supposed to be the cause of CDC-XM positive. After plasmapheresis, CDCXM of both patients turned negative and one patient underwent HTx. His postoperative course was uneventful without rejection. Another patient has remained on the waiting list. Conclusion: Antibody testing for transplantation has allowed a patient’s antibody profile, which contributes to the identification and treatment of antibody-related rejection. CDC-XM positive patients with FCXM negative and undetectable PRA remain on the waiting list under the current system despite of possibility for HTx. We propose introduction of further histocompatibility tests including FCXM for HTx in Japan.