title: Donor-specific HLA antibodies in paediatric cardiac transplant recipients are associated with poor graft survival.
abstract: There is increasing evidence that DSA are associated with poor graft survival, although there are little data in children. We aimed to describe the incidence of DSA in this group and to determine correlation with graft survival. HLA antibodies were analysed in 59 paediatric cardiac transplant recipients. Mean age 10.4 (0.7-18.5) yr, mean time post-transplant 5.1 (0.3-17.3) yr. Antibody detection/identification was performed on the Luminex platform with subsequent identification using Lifescreen Identification kits/One-Lambda Single antigen kits. Forty patients (69%) had no HLA antibodies. DSA were found in four (7%). One had transient Class I antibodies and normal cardiac function. The other three had persistent Class II antibodies (two subsequently required re-transplantation, the third had cardiac failure due to CAV). Non-DSA were found in 15 (25%), all with normal graft function and without rejection. There was no difference in function or CAV prevalence between those with non-DSA and those without antibodies. HLA DSA is uncommon in paediatric cardiac allograft recipients but, if persistent, suggests poorer prognosis. In our series, antibodies to HLA class II on donor tissue were associated with increased graft loss. Routine screening and regular testing are recommended.
authors.affiliation: Department of Pediatric Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK. Claire.irving@nuth.nhs.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Irving
authors.forename: Vaughan
authors.initials: V
authors.lastname: Carter
authors.forename: Gareth
authors.initials: G
authors.lastname: Parry
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
authors.forename: Richard
authors.initials: R
authors.lastname: Kirk
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality; D006085:Graft Survival; D006680:HLA Antigens / Q000097:blood / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology* / Q000401:mortality; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000276:immunology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D015996:Survival Rate; D014019:Tissue Donors; D014181:Transplantation Immunology / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies