title: Immunologic considerations in heart transplantation for congenital heart disease.
abstract: Children and adults with congenital heart disease (CHD) can require interventions that result in immunologic alterations that are different than those seen in patients with cardiomyopathies. Patients with CHD can be exposed to heart surgeries, blood products, valved and non-valved allograft tissue, and mechanical circulatory support, all of which can alter the immunologic status of these patients. This change in immunologic status is most commonly manifested as the development of anti-human leukocyte antigen (HLA) antibodies. This review will delineate a) the causes of anti-HLA anti-body production (often referred to as allosensitization); b) preventive strategies for anti-HLA antibody production before transplantation; c) treatment strategies for those patients who develop anti-HLA antibodies before transplantation; d) consequences of HLA allosensitization after transplantation; and e) treatment of HLA allosensitization and antibody-mediated rejection after transplantation.
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. kaufmanb@email.chop.edu
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaddy
mesh_terms: D000906:Antibodies / Q000276:immunology*; D002648:Child; D003888:Desensitization, Immunologic / Q000379:methods; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy; D006680:HLA Antigens / Q000276:immunology*; D006330:Heart Defects, Congenital / Q000276:immunology / Q000601:surgery; D006331:Heart Diseases / Q000151:congenital* / Q000276:immunology / Q000601:surgery*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D014181:Transplantation Immunology / Q000276:immunology*
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D007166:Immunosuppressive Agents