Experience with Eculizumab in Highly Sensitized Patients Undergoing Heart Transplantation.

The use of eculizumab, which is a complement blockade inhibitor, has been demonstrated to be efficacious in highly sensitized patients undergoing heart transplantation (HTx). The hypothesis is that the complement blockade protects the heart from hyperacute rejection and from other potential adverse responses. It is postulated that the complement blockade may downregulate antibody production. We reviewed our single center study using eculizumab for highly sensitized patients to assess for post-transplant outcomes. Between 2013 and 2020, we assessed 29 HTx patients who are highly sensitized, defined as calculated panel reactive antibody (cPRA) greater than 70% who underwent HTx with eculizumab therapy perioperatively. In all cases, donor-specific antibody (DSA) was crossed at the time of transplant but with a negative CDC prospective crossmatch. Eculizumab was given intraoperatively, post-op day 1, post-op day 7, and then given weekly for the first month and monthly for the second and third months post-transplant. The development of hyperacute rejection, antibody-mediated rejection, hemodynamic compromise rejection, and development of de novo DSA in the first-year post-transplant were assessed. Eculizumab use in highly sensitized patients resulted in 93.1% 1-year survival and no patient developing hyperacute rejection. There were 11 first-year AMR episodes noted, with one episode associated with hemodynamic compromise. All antibody levels began to wane in the first-year post-transplant. The use of eculizumab in highly sensitized patients (crossing DSA at transplant) appears to be effective in allowing these patients to undergo safe heart transplantation. [ABSTRACT FROM AUTHOR]