Antibody depletion for the treatment of crossmatch‐positive pediatric heart transplant recipients |
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Authors: | Christopher S. Almond Tajinder P. Singh Helen Mah Edgar Milford Gregory S. Matte Heather J. Bastardi John E. Mayer Francis Fynn‐Thompson Elizabeth D. Blume |
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Affiliation: | 1. Department of Cardiology, Boston Children's Hospital, , Boston, MA, USA;2. Tissue Typing Laboratory, Brigham & Women's Hospital, , Boston, MA, USA;3. Department of Cardiovascular Surgery, Boston Children's Hospital, , Boston, MA, USA |
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Abstract: | Sensitization to HLA is a risk factor for adverse outcomes after heart transplantation. Requiring a negative prospective CM results in longer waiting times and increased waitlist mortality. We report outcomes in a cohort of sensitized children who underwent transplant despite a positive CDC CM+ using a protocol of antibody depletion at time of transplant, followed by serial IVIG administration. All patients <21 yrs old who underwent heart transplantation at Boston Children's Hospital from 1/1998 to 1/2011 were included. We compared freedom from allograft loss, allograft rejection, and serious infection between CM+ and CM? recipients. Of 134 patients in the cohort, 33 (25%) were sensitized prior to transplantation and 12 (9%) received a CM+ heart transplant. Serious infection in the first post‐transplant year was more prevalent in the CM+ patients compared with CM? patients (50% vs. 16%; p = 0.005), as was HD‐AMR (50% vs. 2%; p < 0.001). There was no difference in freedom from allograft loss or any rejection. At our center, children transplanted despite a positive CM had acceptable allograft survival and risk of any rejection, but a higher risk of HD‐AMR and serious infection. |
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Keywords: | pediatric heart transplantation anti‐HLA antibody plasmapheresis outcome infectious risk antibody‐mediated rejection |
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