Patty and I had a long conversation this afternoon with another of Patty’s health care providers (we won’t name him, but we do trust his opinions a great deal.) This individual was encouraged that Patty’s antibodies had dropped, even if one of the classes of antibodies continues to be at a high percentage. He suggested that progress on these numbers could continue over time, and even if they ultimately needed to transplant against crossmatch, they could be doing so with a less positive crossmatch (or, in other words, a heart better suited to Patty, if not ideal.) He added that although transplanting against crossmatch is not an ideal situation, they have done it successfully several times in the past.
He mentioned that if Patty’s condition were to worsen significantly, an LVAD may be the best option, although he would prefer to avoid this middle step, which involves major surgery and is not without complications and risks. He added that Patty would likely need an external VAD, such as the Thoratec, because the implanted HeartMate would be too big for Patty.
This doctor wants to focus on getting Patty’s antibodies driven down further. Patty will be admitted to the hospital on Monday and will undergo plasmapheresis in an attempt to “scrub” her blood of antibodies. Antibodies can come back, however, so this is not a sure success. Doctors will also perform a catheterization to check how well Patty’s heart is pumping blood. The goals here are to make her a better transplant candidate and make her feel better in the interim.
Doctors may ultimately opt to use total lymphoid irradiation (TLI) as a means to reduce antibodies. The doctor explained that this procedure involves using low radiation doses specifically focused on lymph nodes. Generally, this process does not result in hair loss, illness or other symptoms commonly associated with radiation treatment. However, its effectiveness has not been as extensively documented as other approaches.
Ultimately, the doctor shared that although Patty’s situation is severe, they will be paying close attention to the evolution of her heart failure and will be there to take the next steps whenever they are needed.