title: Outcomes in highly sensitized pediatric heart transplant patients using current management strategies.
abstract: BACKGROUND
  Previous studies have suggested that children with pre-formed anti-HLA antibodies (PRA) undergoing orthotopic heart transplantation (OHT) have increased risk for rejection, coronary artery vasculopathy (CAV) and death. In 2005, our program started utilizing aggressive desensitization (including plasmapheresis, IVIg, pulse cytoxan and rituximab) with the goal of improving outcomes for these patients. The purpose of this study was to compare outcomes with this new strategy in recipients with pre-OHT high PRA (>10%) vs low PRA ≤10%).
  
  
  METHODS
  A retrospective study of 70 consecutive pediatric OHT patients was undertaken between January 2005 and July 2013 to identify patients with pre-OHT PRA >10% (high PRA), or PRA ≤10% (low PRA). Demographic/data information and detailed post-OHT outcomes, including rejection, 30-day and overall mortality, freedom from significant rejection, and CAV, were analyzed.
  
  
  RESULTS
  Fourteen (20%) patients had high PRA and 56 (80%) did not. There was a significant decrease in PRA values before and after desensitization. Thirty-day and overall mortality and the proportion of patients with rejections or CAV were lower in the high PRA group, although the difference was not statistically significant. Kaplan-Meier survival analysis revealed no significant difference in survival between the two groups. There was a significant difference in survival in our sensitized patients before 2005 vs after 2005.
  
  
  CONCLUSIONS
  We identified no significant differences in outcomes between high or low PRA patients. These preliminary findings may suggest improvement in OHT outcomes for high PRA patients as a result of aggressive desensitization. A larger study is warranted to confirm these findings.
authors.affiliation: Divisions of Pediatric Cardiology. Electronic address: akorang@me.com.
authors.forename: Alfred
authors.initials: A
authors.lastname: Asante-Korang
authors.affiliation: Clinical and Translational Research Organization, All Children's Hospital/Johns Hopkins Medicine, St Petersburg, Florida.
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Amankwah
authors.affiliation: Lifelink Immunology Lab, Tampa, Florida.
authors.forename: Mayra
authors.initials: M
authors.lastname: Lopez-Cepero
authors.affiliation: Divisions of Pediatric Cardiology.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ringewald
authors.affiliation: Divisions of Pediatric Cardiology.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carapellucci
authors.affiliation: Divisions of Pediatric Cardiology.
authors.forename: Diane
authors.initials: D
authors.lastname: Krasnopero
authors.affiliation: Divisions of Pediatric Cardiology.
authors.forename: Alex
authors.initials: A
authors.lastname: Berg
authors.affiliation: Division of Cardiac Surgery, All Children's Hospital/Johns Hopkins University, St Petersburg, Florida.
authors.forename: James
authors.initials: J
authors.lastname: Quintessenza
authors.affiliation: Division of Cardiac Surgery, All Children's Hospital/Johns Hopkins University, St Petersburg, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D010956:Plasmapheresis / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: antibodies; human leukocyte antigen; pediatric, heart; sensitization; transplant