For patients with end-stage heart disease and borderline hemodynamics, high human leukocyte antigen allosensitization presents a barrier to heart transplantation in a timely manner. Conventional desensitization protocols are inadequate in this context due to time constraints and for the most highly reactive immunologically. We previously reported performing heart after liver transplant with domino liver transplant on a single patient without liver disease. We describe this patient's course to date as well as 4 subsequent patients listed for this novel therapy. This experience demonstrates that the liver effectively confers immunoprotection to the heart for patients with high-titer, preformed antibodies. This strategy may provide some measure of equity for demographic groups previously disadvantaged for heart transplantation due to allosensitization.

中文翻译：

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高度致敏的患者在肝移植后有或没有多米诺骨牌后被列为心脏。


对于终末期心脏病和临界血流动力学患者，高人类白细胞抗原同种异体增敏对及时的心脏移植构成了障碍。由于时间限制，在这种情况下，传统的脱敏方案是不够的，并且对于免疫反应性最强的患者。我们之前报道了对一名无肝病的患者进行肝移植后多米诺肝移植手术。我们描述了该患者迄今为止的病程以及为这种新疗法列出的 4 名后续患者。这一经验表明，肝脏有效地为具有高滴度、预先形成抗体的患者提供心脏免疫保护。该策略可能为以前因同种异体增敏而在心脏移植方面处于不利地位的人口群体提供一些公平措施。