Antibody Desensitization Treatment

Sometimes, people with heart failure face the decision of being listed for a transplant. However, not everyone qualifies for a heart transplant. Having high antibody levels (also called highly sensitized) is a common reason.¹

The person must find a transplant center willing to list them despite this diagnosis, whether at a local center, one within a few hours of where they live, or one requiring relocation. Regardless of the center, if the person has high antibody levels, doctors discuss using antibody desensitization as part of the potential transplant process.¹

Is antibody desensitization necessary?

First, everyone has antibodies! Our bodies make antibodies from the time we are born until we die. They are part of the body's defense system called the immune system. We get vaccines to help our bodies make antibodies before we are exposed to certain diseases. Unfortunately, having too many antibodies puts you at risk for rejecting the donor organ. This is why desensitization is necessary. Certain things can cause a person to have too many antibodies when it comes to being listed for a transplant, including:^2,3

• Prior transplantation
• Pregnancy
• Transfusion
• Use of someone else’s human tissue for certain medical treatments, such as cardiac valve replacement
• Being African American
• Viral infections
• Flu vaccine
• Using ventricular assist devices (VADs)

What are the options and how do they work?

There are multiple antibody desensitization methods:^1-3

• Plasmapheresis (plasma-FER-ee-sis) is usually involved because it removes antibodies from blood currently circulating through the person's body. To be effective, it must be done at least 3 to 4 times. Unfortunately, this method alone allows antibodies to come back.
• IVIG uses specially extracted antibodies from thousands of blood donors. It lowers the person’s natural antibody production.
• Rituximab is a synthetic “antibody” that tells the person’s body to kill specific immune cells capable of making new antibodies.
• Bortezomib is a medicine that kills cells making certain antibodies. Additionally, this can be used with plasmapheresis.
• While there are other antibody desensitization options, most need additional evaluations for use in heart transplant candidates.

What are the side effects of antibody desensitization?

Each form of antibody desensitization has its own side effects. Low blood pressure, allergic reactions, or blood-borne infections are side effects of plasmapheresis. IVIG and rituximab side effects include headache, chills, fever, nausea, and abdominal pain, to name a few. In some cases, people experience sensory neuropathy.¹

The severity of the symptoms varies between people and may change in intensity over time (or with continued treatments). For example, I experienced nausea after my first round of antibody desensitization. After my second round, I developed a small shingles rash and neuropathy. Fortunately, my shingles went away. However, I still suffer with minor neuropathy in my toes almost 2 years later.

Is it worth the risk?

Several factors determine the success of antibody desensitization. First, its ability to lower antibodies to a level that allows a person with heart failure to match to a donor is important. If that doesn't work, then transplant isn't possible. Second, the survival rate following transplant matters. Finally, its ability to lower the risk of rejection plays a role.^1-3

In general, antibody desensitization treatments work for transplants, including heart transplants. The overall effectiveness depends on the approach. Like any procedure, nothing is guaranteed. Most information about antibody desensitization comes from kidney – not heart – transplant studies.^1-3

Speaking from personal experience, I went from not being listed to receiving calls for 3 possible hearts after antibody desensitization. Although I recovered and no longer need a transplant, my personal opinion is that antibody desensitization was totally worth it.