title: Changes in the methodology of pre-heart transplant human leukocyte antibody assessment: an analysis of the United Network for Organ Sharing database.
abstract: BACKGROUND
  We sought to investigate temporal trends in the methodology of human leukocyte antibody assessment in heart transplantation.
  
  
  METHODS
  The United Network for Organ Sharing database was queried from June 2004 to March 2013 to obtain pre-heart transplantation human leukocyte antibody results. The % panel reactive antibody for class I and II antibodies was recorded along with the methodology of assessment. Allosensitization was defined as class I and/or II panel reactive antibody of ≥ 10%. The primary outcome measure was graft survival.
  
  
  RESULTS
  During the study period, 12,858 patients with available data underwent heart transplantation. The prevalence of allosensitization increased, with 16.8% in 2005-2006 sensitized at the time of transplantation compared to 23.1% in 2010-2011 (p < 0.001); this occurred in conjunction with an increase in the utilization of flow cytometry (77.2% in 2005-2006; 97.0% in 2010-2011, p < 0.001). Using multivariable analysis, a positive pre-heart transplantation panel reactive antibody by flow cytometry independently predicted graft loss.
  
  
  CONCLUSIONS
  There has been a recent increase in flow cytometric assessment of human leukocyte antibodies prior to heart transplantation, which may be associated with an increase in the prevalence of pre-transplant patients being characterized as allosensitized. Flow cytometry may identify patients with the highest likelihood of graft loss.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: O'Connor
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Britton C
authors.initials: BC
authors.lastname: Keeshan
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Lin
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Monos
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Curt
authors.initials: C
authors.lastname: Lind
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Paridon
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Mascio
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaddy
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
mesh_terms: D015415:Biomarkers / Q000097:blood; D016208:Databases, Factual; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation; D006650:Histocompatibility Testing / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D014481:United States
chemical_list: D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies
keywords: allosensitization; antibody-mediated rejection; cross-matching; heart transplantation; immunogenetics