Mortality and Morbidity in Pre-sensitized Pediatric Heart Transplant Recipients With a Positive Donor Crossmatch Utilizing Peri-operative Plasmapheresis and Cytolytic Therapy

Background The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart transplant candidates who show evidence of antibodies to multiple human leukocyte antigens (pre-sensitized patients). Methods We utilized a protocol...

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Published inThe Journal of heart and lung transplantation Vol. 26; no. 9; pp. 876 - 882
Main Authors Holt, D. Byron, MD, Lublin, Douglas M., MD, Phelan, Donna L., CHS, Boslaugh, Sarah E., PhD, MPH, Gandhi, Sanjiv K., MD, Huddleston, Charles B., MD, Saffitz, Jeffrey E., MD, Canter, Charles E., MD
Format Journal Article
LanguageEnglish
Published New York, NY Elsevier Inc 01.09.2007
Elsevier Science
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Abstract Background The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart transplant candidates who show evidence of antibodies to multiple human leukocyte antigens (pre-sensitized patients). Methods We utilized a protocol that included peri-operative plasmapheresis, thymoglobulin and cyclophosphamide in 17 pre-sensitized (panel-reactive antibodies [PRA] >10%) pediatric patients to accept donors for these patients without a prospective crossmatch between 1995 and 2005. A retrospective review of survival, rejection and infection was performed, comparing the frequency of rejection and infection in our patients who were transplanted with a complement-dependent cytotoxic (CDC)-positive donor/recipient crossmatch to those patients transplanted with a negative crossmatch. Results Thirteen of 17 patients were found to have a CDC-positive crossmatch. Actuarial survival after transplantation was 85% at 1 year and 73% at 3 years. Twelve of 13 (92%) of these patients experienced rejection, and 5 of 13 (38%) had recurrent rejection, generally in the first 2 months after transplantation. Rejection was associated with hemodynamic compromise in 58% of first rejection episodes and 67% of episodes of recurrent rejection. The frequency of rejection in these patients was significantly greater than the frequency in patients with a negative crossmatch in the first 6 months after transplantation, but not afterward. The frequency of infection episodes was not significantly different between the groups. Conclusions Heart transplantation in pre-sensitized pediatric recipients with a CDC-positive donor/recipient crossmatch may result in reasonable short-term survival, but with a high frequency of early rejection, often with hemodynamic compromise.
AbstractList The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart transplant candidates who show evidence of antibodies to multiple human leukocyte antigens (pre-sensitized patients). We utilized a protocol that included peri-operative plasmapheresis, thymoglobulin and cyclophosphamide in 17 pre-sensitized (panel-reactive antibodies [PRA] >10%) pediatric patients to accept donors for these patients without a prospective crossmatch between 1995 and 2005. A retrospective review of survival, rejection and infection was performed, comparing the frequency of rejection and infection in our patients who were transplanted with a complement-dependent cytotoxic (CDC)-positive donor/recipient crossmatch to those patients transplanted with a negative crossmatch. Thirteen of 17 patients were found to have a CDC-positive crossmatch. Actuarial survival after transplantation was 85% at 1 year and 73% at 3 years. Twelve of 13 (92%) of these patients experienced rejection, and 5 of 13 (38%) had recurrent rejection, generally in the first 2 months after transplantation. Rejection was associated with hemodynamic compromise in 58% of first rejection episodes and 67% of episodes of recurrent rejection. The frequency of rejection in these patients was significantly greater than the frequency in patients with a negative crossmatch in the first 6 months after transplantation, but not afterward. The frequency of infection episodes was not significantly different between the groups. Heart transplantation in pre-sensitized pediatric recipients with a CDC-positive donor/recipient crossmatch may result in reasonable short-term survival, but with a high frequency of early rejection, often with hemodynamic compromise.
Background The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart transplant candidates who show evidence of antibodies to multiple human leukocyte antigens (pre-sensitized patients). Methods We utilized a protocol that included peri-operative plasmapheresis, thymoglobulin and cyclophosphamide in 17 pre-sensitized (panel-reactive antibodies [PRA] >10%) pediatric patients to accept donors for these patients without a prospective crossmatch between 1995 and 2005. A retrospective review of survival, rejection and infection was performed, comparing the frequency of rejection and infection in our patients who were transplanted with a complement-dependent cytotoxic (CDC)-positive donor/recipient crossmatch to those patients transplanted with a negative crossmatch. Results Thirteen of 17 patients were found to have a CDC-positive crossmatch. Actuarial survival after transplantation was 85% at 1 year and 73% at 3 years. Twelve of 13 (92%) of these patients experienced rejection, and 5 of 13 (38%) had recurrent rejection, generally in the first 2 months after transplantation. Rejection was associated with hemodynamic compromise in 58% of first rejection episodes and 67% of episodes of recurrent rejection. The frequency of rejection in these patients was significantly greater than the frequency in patients with a negative crossmatch in the first 6 months after transplantation, but not afterward. The frequency of infection episodes was not significantly different between the groups. Conclusions Heart transplantation in pre-sensitized pediatric recipients with a CDC-positive donor/recipient crossmatch may result in reasonable short-term survival, but with a high frequency of early rejection, often with hemodynamic compromise.
Author Holt, D. Byron, MD
Huddleston, Charles B., MD
Phelan, Donna L., CHS
Gandhi, Sanjiv K., MD
Saffitz, Jeffrey E., MD
Lublin, Douglas M., MD
Boslaugh, Sarah E., PhD, MPH
Canter, Charles E., MD
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  fullname: Boslaugh, Sarah E., PhD, MPH
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  fullname: Gandhi, Sanjiv K., MD
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  fullname: Huddleston, Charles B., MD
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  fullname: Saffitz, Jeffrey E., MD
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  fullname: Canter, Charles E., MD
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IsPeerReviewed true
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Issue 9
Keywords Human
Heart
Suboptimal donor
Pediatrics
Therapy
Respiratory disease
Mortality
Cardiovascular disease
Transplantation
Homotransplantation
Epidemiology
Morbidity
Plasmapheresis
Treatment
Surgery
Graft
Child
Language English
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Elsevier Science
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Snippet Background The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart...
The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart transplant...
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SubjectTerms Adolescent
Adult
Antilymphocyte Serum - therapeutic use
Biological and medical sciences
Child
Child, Preschool
Cyclophosphamide - therapeutic use
Cytotoxicity Tests, Immunologic
Graft Rejection - therapy
Heart Transplantation
Histocompatibility
HLA Antigens - immunology
Humans
Immunosuppressive Agents - therapeutic use
Infant
Isoantibodies - blood
Medical sciences
Perioperative Care
Plasmapheresis
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Title Mortality and Morbidity in Pre-sensitized Pediatric Heart Transplant Recipients With a Positive Donor Crossmatch Utilizing Peri-operative Plasmapheresis and Cytolytic Therapy
URI https://www.clinicalkey.es/playcontent/1-s2.0-S1053249807005244
https://dx.doi.org/10.1016/j.healun.2007.07.011
https://www.ncbi.nlm.nih.gov/pubmed/17845925
Volume 26
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