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Tuesday, January 24, 2017
Reducing Antibodies in Lung Transplant Recipient
Is there any way of reducing antibodies in a lung transplant candidate who has been refused transplantation because of this? Are there any medications not currently available in the UK that could be benficial in the reversal of antibodies?
A potential lung transplant candidate may have in their circulation of blood a high level of antibodies to common antigens (ie blood proteins) compared to the general population. The test used to screen for this is the Panel of Reactive Antigens (PRA). If the PRA value is high, this means that should the candidate receive a transplant, then there is a higher chance that their immune system will react to (try to reject) the donor organ (lung).
There are no approved medications or procedures that have been shown to reliably reduce the PRA into a range that would be considered safe to proceed with transplantation.
There have been reports of using the drug mycophenolate mofetil to try to reduce the PRA value before a transplant, but these studies have not been confirmed.
There have also been instances where plasmapheresis (a cleansing of blood proteins via a device similar to dialysis) has been used to reduce the PRA prior to transplant. This has been mostly performed with kidney transplant candidates, but there are a few lung transplant centers who have also tried this approach. Again, this procedure remains unproven.
David R Nunley, MD, FCCP
Former Associate Professor
College of Medicine
The Ohio State University