Pediatric heart transplantation across a positive crossmatch: First year results from the CTOTC-04 multi-institutional study

S. Webber, A. Zeevi, K. Mason, L. Addonizio, E. Blume, A. Dipchand, R. Shaddy, B. Feingold, C. Canter, Daphne T. Hsu, W. Mahle, B. Armstrong, Y. Morrison, D. Ikle, H. Diop, J. Odim

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch-positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7% (CI: 2.7%, 13.3%), sensitized crossmatch positive 18.2% (CI: 2.3%, 51.8%), sensitized crossmatch negative 10.7% (CI: 5.7%, 18.0%), P = .2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Heart Transplantation
Pediatrics
Antibodies
Centers for Disease Control and Prevention (U.S.)
Transplantation
Intravenous Immunoglobulins
Incidence
Immunosuppression
Adrenal Cortex Hormones
Hemodynamics
Maintenance
Transplants
Antigens
Mortality

Keywords

  • Alloantibody
  • Clinical research/practice
  • Crossmatch
  • Heart transplantation/cardiology
  • Pediatrics
  • Rejection: antibody-mediated (ABMR)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Pediatric heart transplantation across a positive crossmatch : First year results from the CTOTC-04 multi-institutional study. / Webber, S.; Zeevi, A.; Mason, K.; Addonizio, L.; Blume, E.; Dipchand, A.; Shaddy, R.; Feingold, B.; Canter, C.; Hsu, Daphne T.; Mahle, W.; Armstrong, B.; Morrison, Y.; Ikle, D.; Diop, H.; Odim, J.

In: American Journal of Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

Webber, S, Zeevi, A, Mason, K, Addonizio, L, Blume, E, Dipchand, A, Shaddy, R, Feingold, B, Canter, C, Hsu, DT, Mahle, W, Armstrong, B, Morrison, Y, Ikle, D, Diop, H & Odim, J 2018, 'Pediatric heart transplantation across a positive crossmatch: First year results from the CTOTC-04 multi-institutional study', American Journal of Transplantation. https://doi.org/10.1111/ajt.14876
Webber, S. ; Zeevi, A. ; Mason, K. ; Addonizio, L. ; Blume, E. ; Dipchand, A. ; Shaddy, R. ; Feingold, B. ; Canter, C. ; Hsu, Daphne T. ; Mahle, W. ; Armstrong, B. ; Morrison, Y. ; Ikle, D. ; Diop, H. ; Odim, J. / Pediatric heart transplantation across a positive crossmatch : First year results from the CTOTC-04 multi-institutional study. In: American Journal of Transplantation. 2018.
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abstract = "Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch-positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7{\%} (CI: 2.7{\%}, 13.3{\%}), sensitized crossmatch positive 18.2{\%} (CI: 2.3{\%}, 51.8{\%}), sensitized crossmatch negative 10.7{\%} (CI: 5.7{\%}, 18.0{\%}), P = .2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.",
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AU - Webber, S.

AU - Zeevi, A.

AU - Mason, K.

AU - Addonizio, L.

AU - Blume, E.

AU - Dipchand, A.

AU - Shaddy, R.

AU - Feingold, B.

AU - Canter, C.

AU - Hsu, Daphne T.

AU - Mahle, W.

AU - Armstrong, B.

AU - Morrison, Y.

AU - Ikle, D.

AU - Diop, H.

AU - Odim, J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch-positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7% (CI: 2.7%, 13.3%), sensitized crossmatch positive 18.2% (CI: 2.3%, 51.8%), sensitized crossmatch negative 10.7% (CI: 5.7%, 18.0%), P = .2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.

AB - Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch-positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7% (CI: 2.7%, 13.3%), sensitized crossmatch positive 18.2% (CI: 2.3%, 51.8%), sensitized crossmatch negative 10.7% (CI: 5.7%, 18.0%), P = .2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.

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KW - Clinical research/practice

KW - Crossmatch

KW - Heart transplantation/cardiology

KW - Pediatrics

KW - Rejection: antibody-mediated (ABMR)

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