DIAGNOSTICS AND TREATMENT
In the post-transplant world, we can now not only detect antibodies but also assess their quantity and ability to cause harm through special testing available at KIMS Heart and Lung Transplant Institute. We have premiere immunology labs that can support our program in guiding therapy for patients with antibody problems.
- Cardiac imaging: KIMS Heart and Lung Transplant Institute have several imaging modalities to detect acute and chronic rejection, including echocardiography, specialized cardiac MRI, and rubidium PET scanning.
- HLA matching of donors versus recipients allows greater compatible transplants and lesser need for immunosuppression. This leads to better, and faster recovery and better long-term survival.
- Tacrolimus metabolizer status: This allows us to preoperatively decide on the ability of a recipient to metabolize a vital immunosuppressant medication. Right dosing leads to adequate immunosuppression and reduced side effects and renal complications or over suppression. This helps us determine the immediate, short, medium- and long-term outcomes of transplantation.
- Endomyocardial biopsy: This procedure helps diagnose rejection in the first year post-transplantation. This is an invasive procedure used routinely to obtain small samples of the heart muscle, primarily for detecting rejection of a donor heart following heart transplantation.
- Non-invasive tests: We are currently utilizing non-invasive blood tests to detect rejection, like donor-derived cell-free DNA tests. We hope to use the AlloMap test, which has decreased the need for invasive biopsies by 80% across high volume centers in the US. In studies, we are utilizing biomarker analyses including intragraft mRNA transcripts and circulating miRNA.
- Other tests: Our program plans to employ the T-cell immune function test to guide immunosuppression. We are also working on the use of TTV (tenoviral loads) to help titrate and regulate immunosuppression. These are some of the only tests available to let us know how immune-responsive a patient is on immunosuppression.
Treatment
- Anti-rejection medications (immunosuppression): In general, we employ three types of immunosuppressive agents: tacrolimus, mycophenolate mofitil and steroids. This triple-drug regimen helps to prevent rejection of the donor heart and is initiated at the time of transplantation. For patients who are highly sensitized or who have a kidney issue, we may utilize induction therapy with ATG, given in the first few days post-transplant, to help maintain kidney function and further prevent rejection. We also routinely utilize statins in our heart transplant patients. We believe that statins, a cholesterol-lowering medication, also have anti-rejection properties. In our program, rejection rates are down to 5%.
- Desensitization treatments: Being a strong Lung program and the largest in South East Asia, we work with the knowledge & ability to treat and manage highly sensitized patients successfully to transplant. We have an array of treatments to reduce antibodies including IVIG, rituximab, alemtuzumab, bortezomib, eculizumab, and tocilizumab for select cases.
Other treatments: Prophylactic antibiotics are also employed routinely in the perioperative period and after transplant to prevent vir