Summary of a Consensus Conference on the Management of Highly Sensitized Multiorgan Transplant Candidates.

Julie K Heimbach, Joyce W Wald, Mauricio A Villavicencio Theoduloz, Andrew Rosenbaum, Jignesh K Patel, Manish J Gandhi, Richard C Daly, Alexandra Shingina, Timucin Taner, Juliet Emamaullee, Allan B Dietz, Naveen L Pereira, Nathan Cummins, Scott W Biggins, Mark D Stegall, Sudhir S Kushwaha, Alberto Sanchez-Fueyo

Journal: Mayo Clinic proceedings 2025;100(4):700-711

PMID: 40057871

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Abstract

The number of highly sensitized patients in need of a multiorgan transplant is increasing. Criteria informing their transplant candidacy, approaches to management on the waitlist, and protocols related to alloantibody monitoring vary widely. We convened a consensus conference to discuss these different practices in the United States and the United Kingdom and to review the contemporary outcomes of these challenging cases. A detailed analysis of the data regarding the liver allografts' immunoprotective effect on simultaneously transplanted other organs was also completed, and the prospect of the use of liver allografts primarily to facilitate transplantation of highly sensitized patients in need of other organs was discussed. The ethical and allocation-related issues about such prospect were debated with a goal to standardize the approach and provide an evidence-based pathway for pre-, peri-, and post-transplantation management for the highly sensitized multiorgan transplantation candidate.

Address: Mayo Clinic, Rochester, MN, USA. Electronic address: [email protected].; University of Pittsburgh, Pittsburgh, PA, USA.; Mayo Clinic, Rochester, MN, USA.; University of Southern California, Los Angeles, CA, USA.; Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.; King's College, London, UK.; Vanderbilt University, Nashville, TN, USA.; University of Pennsylvania, Philadelphia, PA, USA.

DOI: 10.1016/j.mayocp.2025.01.012

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https://linkinghub.elsevier.com/retrieve/pii/S0025...

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https://medlineplus.gov/organtransplantation.html

MeSH Terms: Humans, Organ Transplantation, Liver Transplantation, United States, Graft Rejection, Isoantibodies, United Kingdom, Waiting Lists