Outcomes in pediatric cardiac transplantation with a positive HLA cross-match


Marc E. Richmond, MD, MS, Program for Pediatric Cardiomyopathy, Heart Failure and Transplantation, Morgan Stanley Children’s Hospital of New York, Babies Hospital 2-North, Room 229N, 3959 Broadway, New York, NY 10032, USA
Tel.: 212 305 6575
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E-mail: mr2306@columbia.edu


Richmond ME, Hsu DT, Mosca RS, Chen J, Quaegebeur JM, Addonizio LJ, Lamour JM. Outcomes in pediatric cardiac transplantation with a positive HLA cross-match.
Pediatr Transplantation 2012: 16: 29–35. © 2011 John Wiley & Sons A/S.

Abstract:  Previous studies have shown poor outcomes in pediatric heart transplant recipients with a high PRA or a positive direct donor–recipient cross-match. This study describes outcomes in patients with a positive cross-match at a large pediatric program. Pediatric heart transplant patients at a large single center between January 1993 and July 2009 were reviewed; those with cross-match data were analyzed. Cross-match data were available in 242/262 (92.4%) patients. Indications for transplant were cardiomyopathy (58%), CHD (32%), and retransplant (7%). PRA was ≥10% in 31/213 (14.6%) patients. A retrospective cross-match was positive in 17/31 (55%) patients with PRA ≥10% and 0/182 with PRA <10%. In positive cross-match patients, rejection frequency in the first year post-transplant was higher than negative cross-match patients (1.69 vs. 0.96 episodes/pt year, p = 0.014). There was no difference in rejection frequency after the first year post-transplant (0.18 vs. 0.12 episodes/pt year, p = 0.14). Overall survival was not significantly different between the groups with a median follow-up time of 4.5 yr. Heart transplantation in patients with a positive cross-match may result in good medium-term survival but a higher frequency of early rejection. Further investigation is warranted to define which patients with a positive cross-match will do poorly.