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Antibody depletion for the treatment of crossmatch‐positive pediatric heart transplant recipients
Author(s) -
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.,
FynnThompson Francis,
Blume Elizabeth D.
Publication year - 2013
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12131
Subject(s) - medicine , heart transplantation , cohort , transplantation , single center , prospective cohort study , surgery , adverse effect , cohort study , risk factor , pediatrics
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 <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 = 0.005), as was HD‐AMR (50% vs. 2%; p < 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.