Outcomes in pediatric cardiac transplantation with a positive HLA cross-match
Article first published online: 23 OCT 2011
© 2011 John Wiley & Sons A/S
Volume 16, Issue 1, pages 29–35, February 2012
How to Cite
Richmond, M. E., Hsu, D. T., Mosca, R. S., Chen, J., Quaegebeur, J. M., Addonizio, L. J. and Lamour, J. M. (2012), Outcomes in pediatric cardiac transplantation with a positive HLA cross-match. Pediatric Transplantation, 16: 29–35. doi: 10.1111/j.1399-3046.2011.01555.x
- Issue published online: 17 JAN 2012
- Article first published online: 23 OCT 2011
- Accepted for publication 13 June 2011
- pediatric heart transplant;
- anti-HLA antibody;
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.