title: Antibody depletion for the treatment of crossmatch-positive pediatric heart transplant recipients.
abstract: Sensitization to HLA is a risk factor for adverse outcomes after heart transplantation. Requiring a negative prospective CM results in longer waiting times and increased waitlist mortality. We report outcomes in a cohort of sensitized children who underwent transplant despite a positive CDC CM+ using a protocol of antibody depletion at time of transplant, followed by serial IVIG administration. All patients <21 yrs old who underwent heart transplantation at Boston Children's Hospital from 1/1998 to 1/2011 were included. We compared freedom from allograft loss, allograft rejection, and serious infection between CM+ and CM- recipients. Of 134 patients in the cohort, 33 (25%) were sensitized prior to transplantation and 12 (9%) received a CM+ heart transplant. Serious infection in the first post-transplant year was more prevalent in the CM+ patients compared with CM- patients (50% vs. 16%; p = 0.005), as was HD-AMR (50% vs. 2%; p < 0.001). There was no difference in freedom from allograft loss or any rejection. At our center, children transplanted despite a positive CM had acceptable allograft survival and risk of any rejection, but a higher risk of HD-AMR and serious infection.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Daly
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Chandler
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
authors.forename: Tajinder P
authors.initials: TP
authors.lastname: Singh
authors.forename: Helen
authors.initials: H
authors.lastname: Mah
authors.forename: Edgar
authors.initials: E
authors.lastname: Milford
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Matte
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Bastardi
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003601:Cytotoxicity Tests, Immunologic; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006333:Heart Failure / Q000276:immunology / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents
keywords: anti-HLA antibody; antibody-mediated rejection; infectious risk; outcome; pediatric heart transplantation; plasmapheresis
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