Antibody depletion for the treatment of crossmatch-positive pediatric heart transplant recipients

Kevin P. Daly*, Stephanie Frances Chandler, 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

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)661-669
Number of pages9
JournalPediatric transplantation
Volume17
Issue number7
DOIs
StatePublished - Nov 1 2013

Keywords

  • anti-HLA antibody
  • antibody-mediated rejection
  • infectious risk
  • outcome
  • pediatric heart transplantation
  • plasmapheresis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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    Daly, K. P., Chandler, S. F., Almond, C. S., Singh, T. P., Mah, H., Milford, E., Matte, G. S., Bastardi, H. J., Mayer, J. E., Fynn-Thompson, F., & Blume, E. D. (2013). Antibody depletion for the treatment of crossmatch-positive pediatric heart transplant recipients. Pediatric transplantation, 17(7), 661-669. https://doi.org/10.1111/petr.12131