Class I and class II anti-HLA antibodies after implantation of cryopreserved allograft material in pediatric patients.
OBJECTIVE
Very little is known regarding the immune response to cryopreserved allograft valves and patch material used in the surgical repair of congenital heart defects.


METHODS
We prospectively measured the frequency of panel reactive antibodies directed against HLA class I (HLA-A, B, and C) and class II (HLA-DR/DQ) alloantigens in 24 children receiving cryopreserved allografts. We compared them with results in 11 previously reported control patients. Sixteen of the study patients underwent placement of a valved conduit (11 pulmonic, 5 aortic) between the right ventricle and pulmonary arteries, 6 underwent patch angioplasty of stenotic vessels with cryopreserved pulmonary artery, and 2 underwent placement of a pulmonary monocusp patch. Study patients had panel reactive antibodies measured before, 1 month, 3 months, and 1 year after the operation.


RESULTS
With allograft implantation, panel reactive antibodies increased from 1.9% +/- 5% before the operation to 62% +/- 33% at 31 +/- 8 days after the operation, 92% +/- 15% at 3.3 +/- 0.6 months after the operation, and 85% +/- 18% at 1.1 +/- 0.2 years after the operation. The control group showed no change in panel reactive antibodies, with a level of 1.6% +/- 1% before the operation, 3.2% +/- 1% 28 +/- 5 days after the operation, and 1.7% +/- 1% 2.7 +/- 0.3 months after the operation. Class II antibodies (anti-HLA-DR/DQ) rose to 49% +/- 35% at 30 +/- 8 days and 70% +/- 26% at 3.3 +/- 0.6 months after the operation.


CONCLUSIONS
Cryopreserved allograft material induces a marked response that involves both class I and class II anti-HLA antibodies within 3 months after operation in children. This alloantibody response may represent a form of "rejection," may have implications for those who require subsequent cardiac transplantation, and may play a role in early allograft failure.
Hawkins
J A
JA
Department of Surgery, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. jhawkins@med.utah.edu
Breinholt
J P
JP
Lambert
L M
LM
Fuller
T C
TC
Profaizer
T
T
McGough
E C
EC
Shaddy
R E
RE
D000293:Adolescent; D001021:Aortic Valve / Q000276:immunology / Q000637:transplantation; D001323:Autoantibodies / Q000276:immunology*; D015415:Biomarkers; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D006084:Graft Rejection / Q000276:immunology; D006330:Heart Defects, Congenital / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000276:immunology / Q000637:transplantation; D014184:Transplantation, Homologous
D001323:Autoantibodies; D015415:Biomarkers; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II