title: Persistence of anti-human leukocyte antibodies in congenital heart disease late after surgery using allografts and whole blood.
abstract: BACKGROUND
  Allografts are used for vascular reconstruction in many forms of congenital heart disease. Although allografts induce anti-human leukocyte antibody (HLA) formation, much about this response is unknown.
  
  
  METHODS
  Three groups of patients aged 8 to 18 years old underwent analysis for class I and II anti-HLA antibodies using Luminex. Groups were defined by timing of allograft exposure and diagnosis at Norwood for hypoplastic left heart syndrome (neonatal group), at Glenn for single-ventricle lesions not requiring arch reconstruction (infant group), and cardiac defects repaired during infancy without allografts (controls). Patients had significant anti-HLA (sensitization) if mean fluorescence intensity was ≥ 1500.
  
  
  RESULTS
  The study enrolled 29 patients (median age, 10.1 years). Significant class I anti-HLA antibodies were seen in 44% (8 of 18) of the neonatal group, 25% (1 of 4) of the infant group, and 14% (1 of 7) of controls; class II anti-HLA antibodies were seen in 44% (8 of 18) of the neonatal group, 25% (1 of 4) of the infant group, and 29% (2 of 7) of controls. All patients received fresh whole blood, but the neonatal group had greater exposure (p = 0.001). There was less sensitization with increasing time from last receipt of allograft(s) or blood transfusion (p = 0.05).
  
  
  CONCLUSIONS
  Exposure to allograft at the Norwood procedure is associated with long-term sensitization to anti-HLA antibodies in 56% of patients. Sensitization also occurs in those without prior exposure to allografts, may decrease over time, and appears related to whole blood. These findings have implications for those in whom heart transplant is considered late in the clinical course.
authors: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA. mjoconnor@uams.edu
authors: Matthew J
authors: MJ
authors: O'Connor
authors: Curt
authors: C
authors: Lind
authors: Xinyu
authors: X
authors: Tang
authors: Jeffrey
authors: J
authors: Gossett
authors: Janice
authors: J
authors: Weber
authors: Dimitrios
authors: D
authors: Monos
authors: Robert E
authors: RE
authors: Shaddy
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000276:immunology*; D001808:Blood Vessels / Q000637:transplantation*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006330:Heart Defects, Congenital / Q000276:immunology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology; D011446:Prospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D006680:HLA Antigens