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Accelerated acute severe antibody-mediated graft failure related to a Ross procedure 17 years earlier.

Authors
  • Andreas, Martin1
  • Freystaetter, Kathrin1
  • Bernardi, Martin H2
  • Zuckermann, Andreas1
  • 1 Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. , (Austria)
  • 2 Division of Cardiothoracic and Vascular Anaesthesia & Intensive Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria. , (Austria)
Type
Published Article
Journal
European Journal of Cardio-Thoracic Surgery
Publisher
Oxford University Press
Publication Date
Feb 21, 2018
Identifiers
DOI: 10.1093/ejcts/ezy052
PMID: 29481612
Source
Medline
License
Unknown

Abstract

A 31-year-old male patient underwent a heart transplantation due to dilated cardiomyopathy. He experienced accelerated acute antibody-mediated rejection despite being negative for human leukocyte antigen antibodies (0% panel-reactive antibodies prior to surgery). Further assessment revealed a common antigen between a homograft implanted 17 years earlier during the Ross procedure and the heart donor. The homograft likely induced specific antibody formation. Interestingly, panel-reactive antibody levels measured 7 years prior to transplantation were 7%. Because of the long time span between the Ross procedure and heart transplantation, no circulating antibodies could be detected in 2015, but reactivation of memory cells might potentially have led to this fulminant rejection episode. For future cases, particular attention should be given to patients with homografts.

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