Outcomes in pediatric cardiac transplantation with a positive HLA cross-match.
Previous studies have shown poor outcomes in pediatric heart transplant recipients with a high PRA or a positive direct donor-recipient cross-match. This study describes outcomes in patients with a positive cross-match at a large pediatric program. Pediatric heart transplant patients at a large single center between January 1993 and July 2009 were reviewed; those with cross-match data were analyzed. Cross-match data were available in 242/262 (92.4%) patients. Indications for transplant were cardiomyopathy (58%), CHD (32%), and retransplant (7%). PRA was ≥10% in 31/213 (14.6%) patients. A retrospective cross-match was positive in 17/31 (55%) patients with PRA ≥10% and 0/182 with PRA <10%. In positive cross-match patients, rejection frequency in the first year post-transplant was higher than negative cross-match patients (1.69 vs. 0.96 episodes/pt year, p = 0.014). There was no difference in rejection frequency after the first year post-transplant (0.18 vs. 0.12 episodes/pt year, p = 0.14). Overall survival was not significantly different between the groups with a median follow-up time of 4.5 yr. Heart transplantation in patients with a positive cross-match may result in good medium-term survival but a higher frequency of early rejection. Further investigation is warranted to define which patients with a positive cross-match will do poorly.
Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital of New York Presbyterian, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. mr2306@columbia.edu
Marc E
ME
Richmond
Daphne T
DT
Hsu
Ralph S
RS
Mosca
Jonathan
J
Chen
Jan M
JM
Quaegebeur
Linda J
LJ
Addonizio
Jacqueline M
JM
Lamour
D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006680:HLA Antigens / Q000737:chemistry / Q000276:immunology*; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
D006680:HLA Antigens