Feingold Brian, Bowman Pam, Zeevi Adriana, Girnita Alin L, Quivers Eric S, Miller Susan A, Webber Steven A
Division of Pediatric Cardiology and Cardiopulmonary Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
J Heart Lung Transplant. 2007 Jun;26(6):565-71. doi: 10.1016/j.healun.2007.03.015.
Little is known about the effect of pre-transplant alloantibody in the pediatric cardiac transplant population.
All cardiac listings (n = 298) at Children's Hospital of Pittsburgh from January 1990 through February 2006 were reviewed to determine the impact of allosensitization on transplantation outcomes. Analysis focused on: (1) wait list outcomes; (2) survival from the time of listing, regardless of subsequent transplantation; (3) post-transplant graft and patient survival; and (4) post-transplant freedom from graft vasculopathy. Institutional policy required a negative, prospective crossmatch for candidates with panel-reactive antibody >20%.
Alloantibody data were available for 252 (85%) listings. Median time to transplantation was greater for sensitized vs non-sensitized subjects (2.7 months vs 1.3 months; p = 0.02). At 1 year after listing, sensitized subjects had a higher incidence of death (22% vs 8.4%; p = 0.055). Survival at all time-points after listing (regardless of transplantation) was worse for sensitized subjects (p = 0.04). Although no statistically significant differences in post-transplant graft or patient survival were noted, pre-transplant allosensitization was associated with decreased freedom from graft vasculopathy (hazard ratio [HR] 2.76, 95% confidence interval [CI] 1.18 to 6.45; p = 0.019).
A policy requiring a negative, prospective crossmatch for highly sensitized candidates is associated with longer wait list time and higher mortality after listing. The development of graft vasculopathy appears to be influenced by the presence of pre-transplant alloantibody.
关于移植前同种异体抗体在小儿心脏移植人群中的作用，目前所知甚少。
回顾了1990年1月至2006年2月匹兹堡儿童医院的所有心脏移植登记病例（n = 298），以确定同种异体致敏对移植结果的影响。分析重点包括：（1）等待名单结果；（2）从登记时起的生存率，无论随后是否进行移植；（3）移植后移植物和患者的生存率；（4）移植后无移植物血管病变。机构政策要求对群体反应性抗体>20%的候选人进行阴性前瞻性交叉配型。
252例（85%）登记病例有同种异体抗体数据。致敏受试者与未致敏受试者相比，移植的中位时间更长（2.7个月对1.3个月；p = 0.02）。登记后1年，致敏受试者的死亡发生率更高（22%对8.4%；p = 0.055）。登记后所有时间点（无论是否移植），致敏受试者的生存率更差（p = 0.04）。虽然移植后移植物或患者生存率没有统计学上的显著差异，但移植前同种异体致敏与移植物血管病变的发生率降低相关（风险比[HR] 2.76，95%置信区间[CI] 1.18至6.45；p = 0.019）。
对高度致敏候选人要求进行阴性前瞻性交叉配型的政策与更长的等待名单时间和登记后更高的死亡率相关。移植物血管病变的发生似乎受移植前同种异体抗体的影响。
