82 M. J. Martinez et al.: J Extra Corpor Technol 2026, 58, 79--84
Figure 1. Separation of blood components in the apheresis machine.
During the first eleven days postoperatively( in the ICU), four TPEs were performed without complications. Good ventricular function, improvement in renal function, and withdrawal of oxygen and inotropes were observed.
In the four days following discharge from the ICU, the final TPE was performed, and two doses of 50 grams of immunoglobulin were administered.
On the tenth postoperative day, the first postoperative PRA for HLA I and II was 0 %. On the thirtieth postoperative day, a catheterization with endomyocardial biopsy showed no evidence of immunological rejection. An echocardiogram showed good graft function. One year later, a catheterization with endomyocardial biopsy showed no signs of humoral rejection. At the time of publication of this article, the patient is in the third-year post-transplant and continues to show no signs of rejection in his progress.
Figure 2. Frontal chest X-ray.
corrected to normal values once the patient reached the range of mild hypothermia( 35 ° C), prior to the termination of extracorporeal circulation.
The patient did not receive any transfusions during CPB. The ultrafiltration volume was 2000 mL. Urine output was 500 mL.
The cell saver was used from the skin incision until the initiation of cardiopulmonary bypass. After the administration of protamine, it was used again until the placement of the sternum mesh. The entire residual volume of the extracorporeal circuit was processed. Total volume processed was 2000 mL.
Results
In the immediate postoperative period, high doses of inotropes and vasopressors were administered. On physical examination, cold extremities, slow capillary refill, and low urine output were observed. The patient also required transfusions of red blood cells, fresh frozen plasma( added to that used in TPE), and platelets. All components were irradiated and leukocyte depleted.
Discussion
Organ transplants have helped thousands of people. The main obstacle lies in the availability of organs, so it is necessary to increase the number of available organs and to find more precise immunosuppressive methods to prevent rejection without the dangerous side effects of infections and cancer.
The role of HLA compatibility in transplant outcomes is considered [ 2 ].
Sensitization remains a limitation for heart transplantation in many potential candidates. Data on current desensitization therapies and their outcomes are limited, despite the strong rationale. Future research should focus on understanding the outcomes of desensitization therapy and evaluating both current and new therapies [ 3 ].
The combination of plasmapheresis and cardiopulmonary bypass allows for the removal of cytotoxic antibodies in patients with positive PRA. The therapeutic effect was sustained when combined with aggressive B-cell immunosuppressive therapy. Plasmapheresis during CPB provided high-flow exchange, which would not be possible in these hemodynamically unstable patients. A major issue when performing plasmapheresis during CPB is the removal of various drugs, such as heparin, anesthetics, aprotinin, steroids, and ionized calcium.