Antibody depletion for the treatment of crossmatch‐positive pediatric heart transplant recipients. (6th August 2013)

• Record Type: Journal Article
• Authors: Daly, Kevin P.; Chandler, Stephanie F.; Almond, Christopher S.; Singh, Tajinder P.; Mah, Helen; Milford, Edgar; Matte, Gregory S.; Bastardi, Heather J.; Mayer, John E.; Fynn‐Thompson, Francis; Blume, Elizabeth D.
• Is Part Of: Pediatric transplantation. Volume 17:Number 7(2013:Nov.)
• Page Start: 661
• Page End: 669
• Publication Date: 2013-08-06
• Subjects: Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.12131
• Languages: English
• ISSNs: 1397-3142

Abstract

<abstract abstract-type="main" id="petr12131-abs-0001"> <title>Abstract</title> <p>Sensitization to HLA is a risk factor for adverse outcomes after heart transplantation. Requiring a negative prospective CM results in longer waiting times and increased waitlist mortality. We report outcomes in a cohort of sensitized children who underwent transplant despite a positive CDC CM+ using a protocol of antibody depletion at time of transplant, followed by serial IVIG administration. All patients &lt;21 yrs old who underwent heart transplantation at Boston Children's Hospital from 1/1998 to 1/2011 were included. We compared freedom from allograft loss, allograft rejection, and serious infection between CM+ and CM− recipients. Of 134 patients in the cohort, 33 (25%) were sensitized prior to transplantation and 12 (9%) received a CM+ heart transplant. Serious infection in the first post‐transplant year was more prevalent in the CM+ patients compared with CM− patients (50% vs. 16%; p<italic> </italic>=<italic> </italic>0.005), as was HD‐AMR (50% vs. 2%; p<italic> </italic>&lt;<italic> </italic>0.001). There was no difference in freedom from allograft loss or any rejection. At our center, children transplanted despite a positive CM had acceptable allograft survival and risk of any rejection, but a higher risk of HD‐AMR and serious infection.</p> </abstract>