| Popis: |
Following transplantation, patients often receive a standardized regimen of maintenance immunosuppression. Biomarker monitoring could help to individualize immune therapy, giving adequate immunosuppression to high risk patients while possibly avoiding toxicity and infection in low risk patients. Furthermore, early detection and immunosuppression dosage changes before clinical dysfunction maybe a cost effective strategy to minimize rejection episodes. The aim of our study was to define the cost associated with an anti-HLA antibody monitoring program over 5 years compared to treating patients for a single acute rejection episode. We hypothesize having a donor specific HLA antibody monitoring program would help to define early rejection before clinical symptoms arise and therefore be a cost benefit. Our study included 23 heart transplant patients diagnosed with either acute cellular rejection (ACR), antibody mediate rejection (AMR) or both. We calculated the average cost associated with the rejection episode including hospital days and treatment for an ACR, AMR or both. For comparison we calculated the cost for an donor specific anti-HLA antibody monitoring program using Flow PRA, HLA antibody specificities and specificity titers using One Lambda Reagents over a 5 year follow-up period. We found the average cost to treat AMR was 200 times greater than the cost for ACR. ACR rejections were treated with steroids, whereas AMR required multiple rounds of plasmapheresis, IVIG and Rituxan. The cost for an HLA monitoring program over 5 years including FPRA and HLA antibody specificities was comparable to a round of plasmapheresis or a single endomyocardial biopsy and appears to offer patients at risk for AMR due to strong sensitization history a cost effective early detection method upon which immunosuppression could be adjusted. The data suggest that early prediction of acute rejection may allow for optimization of therapy prior to major graft damage and make earlier cost effective preventative interventions possible. As a cost effective strategy we propose performing dose adjustments of maintenance immunosuppression after detection of DSA, preventing the need for later costly rejection treatment. |
Full Text from ScienceDirect