UTILIZATION OF INTRAVENOUS IMMUNOGLOBULIN TO AMELIORATE ALLOANTIBODIES IN A HIGHLY SENSITIZED PATIENT WITH A CARDIAC ASSIST DEVICE AWAITINGHEART-TRANSPLANTATION - FLUORESCENCE-ACTIVATED CELL SORTER ANALYSIS

Surgery surrounding the use of mechanical assistance in cardiac transp lant candidates often leads to multiple blood/platelet transfusions an d subsequent development of alloantibodies. This is a case report of a 50-year-old male patient who had received blood transfusions during c oronary bypass grafting 9 years earlier. He presented in acute and chr onic heart failure and, despite therapy, became moribund with multisys tem organ failure, His ejection fraction was 10%. A Novacor ventricula r assist device was implanted on May 19, 1995 (day 0). The patient rec eived 44 U of blood and 20 U of platelets, Although his percent reacti ve antibodies (PRA) were negative before surgery by fluorescence-activ ated cell sorter analysis, the PRA 3 days after implantation of the ve ntricular assist device was 80%; it increased to 100% by day 7. In an attempt to decrease the PRA, intravenous immunoglobulin was given at 3 -week intervals. The PRA became negative and the patient received a do nor heart that was negative by fluorescence-activated cell sorter cros s-match on day 64. On days 69-72, a dramatic increase in alloantibody activity was promptly reversed with additional intravenous immunoglobu lin. Currently at posttransplant month 12, the patient shows no humora l, cellular, or vascular evidence of rejection.