Outcomes in pediatric cardiac transplantation with a positive HLA cross-match

Marc E. Richmond, Daphne T. Hsu, Ralph S. Mosca, Jonathan Chen, Jan M. Quaegebeur, Linda J. Addonizio, Jacqueline M. Lamour

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Previous studies have shown poor outcomes in pediatric heart transplant recipients with a high PRA or a positive direct donor-recipient cross-match. This study describes outcomes in patients with a positive cross-match at a large pediatric program. Pediatric heart transplant patients at a large single center between January 1993 and July 2009 were reviewed; those with cross-match data were analyzed. Cross-match data were available in 242/262 (92.4%) patients. Indications for transplant were cardiomyopathy (58%), CHD (32%), and retransplant (7%). PRA was ≥10% in 31/213 (14.6%) patients. A retrospective cross-match was positive in 17/31 (55%) patients with PRA ≥10% and 0/182 with PRA <10%. In positive cross-match patients, rejection frequency in the first year post-transplant was higher than negative cross-match patients (1.69 vs. 0.96 episodes/pt year, p = 0.014). There was no difference in rejection frequency after the first year post-transplant (0.18 vs. 0.12 episodes/pt year, p = 0.14). Overall survival was not significantly different between the groups with a median follow-up time of 4.5 yr. Heart transplantation in patients with a positive cross-match may result in good medium-term survival but a higher frequency of early rejection. Further investigation is warranted to define which patients with a positive cross-match will do poorly.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalPediatric Transplantation
Volume16
Issue number1
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Keywords

  • HLA
  • anti-HLA antibody
  • outcome
  • pediatric heart transplant
  • survival

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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