Yang Jeremy, Schall Cynthia, Smith Doug, Kreuser Lisa, Zamberlan Mary, King Karen, Gajarski Robert
Department of Pediatrics (Cardiology), University of Michigan, Ann Arbor, Michigan, USA.
J Heart Lung Transplant. 2009 Feb;28(2):123-9. doi: 10.1016/j.healun.2008.11.908.
HLA sensitization rates in children on extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VADs) are unknown. In addition, panel-reactive antibody (PRA) assessment is increasingly being performed by Luminex, whose role in comparison to other conventional methods is unclear. We investigated HLA sensitization of mechanically supported children using established PRA methods and then retested stored serum using Luminex to assess its impact on initial PRA results and post-heart transplant (post-HTx) outcomes.
Data on 22 pre-HTx ECMO or VAD patients (0 to 18 years of age) included: age; duration of mechanical support; use of homograft; red cell transfusion volume; PRAs; and outcome. Comparative data were collected from 10 non-supported, age-matched controls.
Median age of the 13 ECMO and 9 VAD patients was 1.4 and 192 months (p < 0.001), respectively. Six (27%) device patients and 4 (40%) controls had baseline PRAs >10% (p = 0.7). No ECMO but 6 VAD patients were sensitized after 50 +/- 51 days of support (p = 0.02). Compared with ECMO, VAD patients had higher Class I PRAs according to enzyme-linked immunoassay (p = 0.03). VAD patients had higher final vs initial PRAs for Class I (p = 0.05) and II (p = 0.04) antigens. HLA sensitization was independent of transfusion volume. Only complement-dependent cytotoxicity (CDC) Class I PRAs were different from their respective Luminex values (p = 0.03). Four HTx patients with initially low PRAs but elevated post hoc Luminex assays had no rejection at 3.8 +/- 1.6 years post-HTx.
Infants supported with ECMO are at low risk for HLA sensitization. Because it provides full antibody specificity disclosure, Luminex complements more conventional PRA assays by quantitatively identifying potential donor-specific antibodies, which should facilitate the virtual crossmatch process, thereby minimizing post-HTx humoral rejection risk.
接受体外膜肺氧合（ECMO）或心室辅助装置（VAD）治疗的儿童的HLA致敏率尚不清楚。此外，越来越多地通过Luminex进行群体反应性抗体（PRA）评估，其与其他传统方法相比的作用尚不清楚。我们使用既定的PRA方法调查了接受机械支持的儿童的HLA致敏情况，然后使用Luminex对储存的血清进行重新检测，以评估其对初始PRA结果和心脏移植后（HTx后）结局的影响。
22例HTx前接受ECMO或VAD治疗的患者（0至18岁）的数据包括：年龄；机械支持持续时间；同种异体移植物的使用；红细胞输注量；PRA；以及结局。从10名年龄匹配的非支持性对照中收集比较数据。
13例接受ECMO治疗和9例接受VAD治疗的患者的中位年龄分别为1.4个月和192个月（p<0.001）。6例（27%）接受装置治疗的患者和4例（40%）对照的基线PRA>10%（p=0.7）。在支持50±51天后，没有接受ECMO治疗的患者发生致敏，但有6例接受VAD治疗的患者发生致敏（p=0.02）。根据酶联免疫吸附测定，与接受ECMO治疗的患者相比，接受VAD治疗的患者的I类PRA更高（p=0.03）。接受VAD治疗的患者的I类（p=0.05）和II类（p=0.04）抗原的最终PRA高于初始PRA。HLA致敏与输注量无关。只有补体依赖细胞毒性（CDC）I类PRA与其各自的Luminex值不同（p=0.03）。4例初始PRA较低但事后Luminex检测升高的HTx患者在HTx后3.8±1.6年没有发生排斥反应。
接受ECMO支持的婴儿发生HLA致敏的风险较低。由于Luminex能够全面披露抗体特异性，通过定量识别潜在的供体特异性抗体，它对更传统的PRA检测起到补充作用，这应有助于虚拟交叉配型过程，从而将HTx后体液排斥反应的风险降至最低。
