TY - JOUR
T1 - Donor-specific HLA alloantibodies
T2 - Impact on cardiac allograft vasculopathy, rejection, and survival after pediatric heart transplantation
AU - Tran, Andrew
AU - Fixler, David E
AU - Huang, Rong
AU - Meza, Tiffany
AU - Lacelle, Chantale
AU - Das, Bibhuti B
N1 - Publisher Copyright:
© 2016 International Society for Heart and Lung Transplantation.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background There is increasing evidence that donor-specific anti-HLA antibodies (DSA) are associated with poor outcomes after cardiac transplantation in adults, but data are limited in children. The objective of this study was to examine the development and consequences of de novo DSA in pediatric recipients of heart transplants. Methods We analyzed 105 pediatric patients who received heart transplants at our center from January 2002 to December 2012. All patients had negative T-cell and B-cell post-transplant crossmatches. Patients underwent HLA antibody screening at 1, 2, 3, 6, and 12 months post-transplant and annually thereafter unless there was suspicion for rejection. HLA class I and II antibodies were identified using Luminex assay. Coronary angiography was performed at 1 year and annually thereafter. Acute cellular rejection, antibody-mediated rejection, and treated clinical rejections were included together as rejection events. Results Of 105 patients, 45 (43%) developed de novo DSA. DSA-positive patients had significantly higher rates of coronary artery vasculopathy (CAV) compared with DSA-negative patients (36% vs 13%). CAV-free survival at 1 year and 5 years post-transplant for DSA-negative patients was 90% and 25%, respectively, compared with 70% and 0%, respectively, for DSA-positive patients (p < 0.01). DSA-positive patients had 2.5 times more rejection events per year than DSA-negative patients. The 5-year graft survival rate was 72.4% for DSA-negative patients and 21% for DSA-positive patients (p < 0.001). Conclusions De novo DSA has a strong negative impact on CAV, rejection, and graft survival in pediatric recipients of heart transplants.
AB - Background There is increasing evidence that donor-specific anti-HLA antibodies (DSA) are associated with poor outcomes after cardiac transplantation in adults, but data are limited in children. The objective of this study was to examine the development and consequences of de novo DSA in pediatric recipients of heart transplants. Methods We analyzed 105 pediatric patients who received heart transplants at our center from January 2002 to December 2012. All patients had negative T-cell and B-cell post-transplant crossmatches. Patients underwent HLA antibody screening at 1, 2, 3, 6, and 12 months post-transplant and annually thereafter unless there was suspicion for rejection. HLA class I and II antibodies were identified using Luminex assay. Coronary angiography was performed at 1 year and annually thereafter. Acute cellular rejection, antibody-mediated rejection, and treated clinical rejections were included together as rejection events. Results Of 105 patients, 45 (43%) developed de novo DSA. DSA-positive patients had significantly higher rates of coronary artery vasculopathy (CAV) compared with DSA-negative patients (36% vs 13%). CAV-free survival at 1 year and 5 years post-transplant for DSA-negative patients was 90% and 25%, respectively, compared with 70% and 0%, respectively, for DSA-positive patients (p < 0.01). DSA-positive patients had 2.5 times more rejection events per year than DSA-negative patients. The 5-year graft survival rate was 72.4% for DSA-negative patients and 21% for DSA-positive patients (p < 0.001). Conclusions De novo DSA has a strong negative impact on CAV, rejection, and graft survival in pediatric recipients of heart transplants.
KW - cardiac allograft vasculopathy
KW - donor-specific anti-HLA antibodies
KW - heart transplantation
KW - pediatrics
KW - rejections
KW - survival
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U2 - 10.1016/j.healun.2015.08.008
DO - 10.1016/j.healun.2015.08.008
M3 - Article
C2 - 26422083
AN - SCOPUS:84954078258
SN - 1053-2498
VL - 35
SP - 87
EP - 91
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 1
ER -