Faculty Collaboration Database

Outcomes in highly sensitized pediatric heart transplant patients using current management strategies. J Heart Lung Transplant 2015 Feb;34(2):175-81

Date

12/03/2014

Pubmed ID

25447583

DOI

10.1016/j.healun.2014.09.027

Scopus ID

2-s2.0-84922949340 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

BACKGROUND: Previous studies have suggested that children with pre-formed anti-HLA antibodies (PRA) undergoing orthotopic heart transplantation (OHT) have increased risk for rejection, coronary artery vasculopathy (CAV) and death. In 2005, our program started utilizing aggressive desensitization (including plasmapheresis, IVIg, pulse cytoxan and rituximab) with the goal of improving outcomes for these patients. The purpose of this study was to compare outcomes with this new strategy in recipients with pre-OHT high PRA (>10%) vs low PRA ≤10%).

METHODS: A retrospective study of 70 consecutive pediatric OHT patients was undertaken between January 2005 and July 2013 to identify patients with pre-OHT PRA >10% (high PRA), or PRA ≤10% (low PRA). Demographic/data information and detailed post-OHT outcomes, including rejection, 30-day and overall mortality, freedom from significant rejection, and CAV, were analyzed.

RESULTS: Fourteen (20%) patients had high PRA and 56 (80%) did not. There was a significant decrease in PRA values before and after desensitization. Thirty-day and overall mortality and the proportion of patients with rejections or CAV were lower in the high PRA group, although the difference was not statistically significant. Kaplan-Meier survival analysis revealed no significant difference in survival between the two groups. There was a significant difference in survival in our sensitized patients before 2005 vs after 2005.

CONCLUSIONS: We identified no significant differences in outcomes between high or low PRA patients. These preliminary findings may suggest improvement in OHT outcomes for high PRA patients as a result of aggressive desensitization. A larger study is warranted to confirm these findings.

Author List

Asante-Korang A, Amankwah EK, Lopez-Cepero M, Ringewald J, Carapellucci J, Krasnopero D, Berg A, Quintessenza J, Jacobs JP

Author

Ernest Amankwah PhD Director, Associate Professor in the Clinical and Translational Science Institute department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Disease Management
Female
Florida
Follow-Up Studies
Graft Rejection
Graft Survival
HLA Antigens
Heart Failure
Heart Transplantation
Histocompatibility Testing
Humans
Immunoglobulins, Intravenous
Immunologic Factors
Infant
Infant, Newborn
Kaplan-Meier Estimate
Male
Plasmapheresis
Practice Guidelines as Topic
Prognosis
Retrospective Studies
Survival Rate
Young Adult