Re: heart transplant

Posted By CCF CARDIO  MD-APS on December 16, 1997 at 15:02:08:

In Reply to: heart transplant posted by Jan on December 04, 1997 at 20:01:07:







: I am glad to find this forum!  I have dilated cardiomyopathy and had a blood test called a PRA, to test for heart transplant compatability.  It is an antibodies test.  My rejection rate was 79% on the test.  My doctors say this sometimes happens when someone has had several blood transfusions or multiple pregnancies.  What does all of this mean?  Does this probably preclude me from being a transplant candidate if I am healthy in every other way?  Does it mean a donner must have the same proportion of antibodies in their blood to be a match for me?  Why would it take longer to find a match because of the antibodie count?  My blood type is A+.  One of my doctors on the transplant team said because of the antibodie problem a transplant was probably not an option.  The other said it would be possible, but would probably take a longer.  I know you can't tell me about my specific case, but please help me understand what the antibodie test is all about and how and why it effects heart transplant possibilities.  Does each hospital have their own individual criteria of who is a transplant candidate and who isn't?  Or is the criteria universal?  Thank you for your forum.  It is a Godsend to us who are bewildered.













Dear Jan,
     In regards to your "antibody" test, a high percentage like yours poses a problem with the likelihood that you will reject most donors. These antibodies that you built up in response to blood transfusions or pregnancies will seek and destroy( inflame, reject) anything that is placed(transplanted) in your body that resembles in any way proteins that you have been exposed to in the past(this includes proteins in the transfused blood and or on a fetus as it grows in the womb) There are hundreds to thousands of antigens(proteins) on the surfaces of red blood cells, some of which your body recognized as foreign with each blood transfusion.  When the body sees a "foriegn" protein it makes an antibldy to it and literally builds and stores an army of those particular antibodies that it can recall in a hurry should it ever see that foriegner again; this is a good system if you are fighting a virus that rears it's ugly head
at you on more than one occasion because on the second presentation the army of antibodies that are ready and waiting come at that "foreigner" with great force with intent to destroy. In the case of an infectious virus, the army protects you from getting infected again.  however in the case of organ transplant it works against the transplanted organ being accepted in to the host body, i.e the more antigens(proteins) on the surface of the cells of the transplanted organ that are recognized as foreign, the more the body will try to reject that organ.  A general rule in transplanted hearts is: the more rejection of the heart, the worse it's functon(even if the heart was completely normal) and more rejection means the heart will not survive very long in the patient.  It is even possible that the heart will be immediately rejected, i.e. as it is being transplanted in the operating room, and this is disatrous.  
You might wonder what we know or can do to keep those antibodies at bay as we transplant the heart, well all transplant patients receive immunosuppressive agents to keep their bodies from rejecting the organ that is transplanted, but you must know that the body's immune system is a very powerful system with a great memory for foriegn antigens or proteins that it has seen in the past, and unfortunately our drugs of immunosuppression at present are a weak match for someone like you who has so many antibodies. But as is always the case in medicine nothing is 100%predictable, and so your doctors have more than one stategy to consider as well as the fact that a transplant may not be in your best interest right now.  I do not know the details of the transplant committees that decide who gets what heart but I can say that they do the absolute best they can to match blood types and other "antigens" as best they can in
to give the patient who gets the heart the greatest chance at survival and for as long a period of time as possible.  
     Let me try to simplify this for you.  A donor for you firstly would have to be the same blood type(A+), secondly there would be a "long" wait for a donor who when tested does not show many antigens that you are known to have antibodies against, this is a possibility but it is a long wait because it is a rare situation.
I hope that this answer helps you to better understand your situation and why your transplant doctors are considering options other than transplant for you.  If you plan on seeking a second opinion, The Cleveland Clinic Foundation has a heart transplant center, and an appointment can be made by calling 1-800-CCF-CARE.
     Information provided in the heart forum is intended for general medical informational purposes only.  Any diagnosis and or treatment can only be made by your physician(s).