Transplant Evaluations Immunology

Pre-Transplant Immunologic Assessment

Columbia University Medical Center's immunologists have pioneered a complex process for screening a patient's blood serum to determine its "alloreactivity," indicating how well the patient may fare after transplantation, when organ rejection must be controlled by administering immunosuppressants. This screening tells if a patient's immune system is highly sensitized to external factors before the transplantation. Once we have identified the specific pattern of alloreactivity, we correlate that pattern to rejection outcomes after transplantation.

If the screening indicates a profile of heightened immune sensitivity, we have established regimens of immunosuppressants to administer prior to the transplant operation, thereby reducing the patient's immunologic activation. We use a regimen consisting of immunoglobulin with low-dose cyclophosphamide, administered intravenously. This regimine helps to:

• reduce allosensitization,
• shorten the waiting time to transplantation, and
• reduce the frequency of rejection episodes after the operation.

For those patients receiving a cardiac assist device as a bridge-to-transplantation, a variety of immunologic tests have been established to monitor T-cell and B-cell activation. These tests help to identify a patient's risk for increased susceptibility to infections, as well as autoimmunity. Furthermore, we are developing an immune-based treatment protocol for bridge-to-transplant patients at the time of device implantation to stave off heightened T-cell activation.