Wright Eric J, Fiser William P, Edens R Erik, Frazier Elizabeth A, Morrow W Robert, Imamura Michiaki, Jaquiss Robert D B
Division of Pediatric Cardiothoracic Surgery, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA.
J Heart Lung Transplant. 2007 Nov;26(11):1163-9. doi: 10.1016/j.healun.2007.07.042. Epub 2007 Sep 27.
Children undergoing heart transplantation who have preformed anti-human leucocyte antigen (HLA) panel reactive antibodies (PRA) or positive retrospective crossmatch (XM) may be at increased risk for rejection and graft failure. We assessed outcomes of transplant recipients with either positive PRA before transplant or positive retrospective XM.
A review of 148 heart transplant patients between 1990 and 2006 was undertaken, identifying transplants in patients with pre-transplant PRA > 1% and/or a positive XM. Demographic information and detailed post-transplant outcomes including episodes of rejection, infection, and graft failure were recorded.
There were 11 PRA positive (PRA+) transplants, 135 PRA negative (PRA-) transplants, and no PRA data on 2. There were 14 XM+ transplants, 115 XM- transplants, and no XM data on 19. Kaplan-Meier graft survival was better in XM- than XM+ patients (p < 0.015), but not different between PRA+ and PRA- Groups. Timing of first rejection and number of rejection episodes were not different between XM+ and XM- Groups or between PRA+ and PRA- Groups. Infections were not different between PRA or XM Groups. Four patients were PRA+/XM- (all PRA, 1%-10%), 7 were PRA-/XM+, and 7 were PRA+/XM+ (6 of 7 PRA >10%).
Pediatric heart transplant patients whose retrospective XM is positive are at significantly increased risk for graft failure. Elevated pre-transplant PRA may not predict increased risk of graft failure, although markedly positive PRA (>10%) predicts a positive retrospective XM. Improved treatment for pediatric transplant patients with a positive retrospective XM is needed.
接受心脏移植的儿童若预先存在抗人类白细胞抗原（HLA）群体反应性抗体（PRA）或回顾性交叉配型（XM）阳性，可能发生排斥反应和移植失败的风险增加。我们评估了移植前PRA阳性或回顾性XM阳性的移植受者的结局。
回顾了1990年至2006年间的148例心脏移植患者，确定移植前PRA>1%和/或XM阳性患者的移植情况。记录人口统计学信息和详细的移植后结局，包括排斥反应、感染和移植失败的发作情况。
有11例PRA阳性（PRA+）移植，135例PRA阴性（PRA-）移植，2例无PRA数据。有14例XM+移植，115例XM-移植，19例无XM数据。XM-患者的Kaplan-Meier移植存活率优于XM+患者（p<0.015），但PRA+组和PRA-组之间无差异。XM+组和XM-组之间或PRA+组和PRA-组之间首次排斥反应的时间和排斥反应发作次数无差异。PRA或XM组之间的感染情况无差异。4例患者为PRA+/XM-（所有PRA为1%-10%），7例为PRA-/XM+，7例为PRA+/XM+（7例中有6例PRA>10%）。
回顾性XM阳性的小儿心脏移植患者发生移植失败的风险显著增加。移植前PRA升高可能无法预测移植失败风险增加，尽管明显阳性的PRA（>10%）可预测回顾性XM阳性。需要改进对回顾性XM阳性的小儿移植患者的治疗。
