Page 16 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

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d. MMF (up to 600 mg/m as tolerated) is given to inhibit T helper cells.
e. Coordinator will update any change in HLA antibody profile and number of
unacceptable antigens in UNet
o If a heart becomes available to the patient, please order STAT cross match - Page 214-822-
7374 (HLA supervisor pager) to notify. HLA lab will send a technician to pick up the sample
and the result will be available in 4 hours

Protocol for Patients with a Positive Retrospective Cross-Match
The following protocol is based on the CTOTC-04 study. This protocol will be used for all sensitized
patients with significant DSAs identified by virtual cross match at the time of heart transplantation.

Pre-Transplant Protocol:

Patient who have HLA antibodies identified at time of evaluation require a virtual cross-match when a
donor becomes available. Coordinator will call HLA Lab at the time of donor offer.

Peri-Transplant Protocol:

 Standard intraoperative steroids pre cross clamp release
 Peri-operative antibody removal will be performed via plasmapheresis at start of
cardiopulmonary bypass (CPB) and/or within 4 hours of CPB initiation.
 A minimum of one and maximum of three volume plasmapheresis will be performed depending
on MFI of DSAs (<4000MFI = 1 vol, 4000-8000MFI = 2 vol, >8000MFI = 3 vol)

Post-Transplant Protocol:

Induction:

Thymoglobulin Induction per protocol to be given after plasmapheresis

The following additional steps will be followed if retrospective cross match returns positive.

Plasmapheresis:

 Post-operative plasmapheresis will be performed within 24 hours of patient arrival to the ICU
following transplant.
 Plasmapheresis will be performed per our institution protocol – coordinator to alert Blood Bank
 A 1-1.5 volume exchange will be performed daily for the first five days after transplantation
 Further days of plasmapheresis may be given at the discretion of the transplant team

Intravenous Immunoglobulin (IVIG):
First dose to be given within 24 hours of the last planned plasmapheresis post-transplant (may give as a
single 2 g/kg infusion or 2 x 1 g/kg infusions over two days). Five additional doses will be given at
monthly intervals.

Corticosteroids:

 Post-operative day 1-5 as per routine protocol
 After post-operative day 5, daily dosing of 0.25 mg/kg/day, with a maximum dose of 20 mg daily

Updated November 9, 2017 16