title: Development and Impact of De Novo Anti-HLA Antibodies in Pediatric Heart Transplant Recipients.
abstract: There is increasing evidence that de novo anti-HLA antibodies, more specifically de novo donor-specific antibodies (DSA) following solid organ transplantation may be associated with negative outcomes including rejection in the first year and graft loss. Limited data are available in pediatric heart transplant recipients. We sought to prospectively determine the incidence, class and early impact of de novo anti-HLA antibodies in a cohort of pediatric heart transplant recipients. Serial panel reactive antibody testing posttransplant was performed in 25 patients (14 males) transplanted between January 2008 and June 2010. Five patients were sensitized pretransplant; all patients had negative direct crossmatch. Seventy-two percent developed de novo anti-HLA antibodies at a median of 2.6 weeks (IQR 1.2 weeks to 6.2 months) posttransplant; 67% of these were DSA. The majority of recipients in our cohort developed de novo anti-HLA antibodies within the first year posttransplant, with two-thirds being donor-specific. Acute cellular rejection, though frequent, was not different in patients with antibody development regardless of class or specificity, and there was no antibody-mediated rejection, graft loss or early cardiac allograft vasculopathy.
authors.affiliation: Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: C K
authors.initials: CK
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Conway
authors.affiliation: Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Allain-Rooney
authors.affiliation: Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: B W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: Department of Medicine and Histocompatibility Laboratory, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Tinckam
authors.affiliation: Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A I
authors.initials: AI
authors.lastname: Dipchand
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D011446:Prospective Studies
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens
keywords: alloantibody; clinical research / practice; heart transplantation / cardiology; panel reactive antibody (PRA)