Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4399, USA.
J Heart Lung Transplant. 2010 Jan;29(1):109-16. doi: 10.1016/j.healun.2009.08.028.
Ventricular assist devices (VAD) are associated with the formation of antibodies to anti-human leukocyte antigens (HLA) or sensitization. The incidence and effects of VAD-associated anti-HLA sensitization have not been well studied in the pediatric population.
A retrospective review of all patients undergoing VAD implant at our institution from 1998 to 2008 was performed. Panel reactive antibody (PRA) results before VAD implant, after VAD implant, and after orthotopic heart transplantation (OHT) were recorded. Patients who became sensitized (PRA for class I and/or II immunoglobulin G antibodies >or= 10%) on VAD support were compared with non-sensitized patients with regard to demographics, diagnosis, device type, and blood product exposure on VAD support. Outcomes after OHT were also compared between groups.
VAD support was initiated in 20 patients (median age, 14.4 years), with 75% survival to OHT or recovery. PRA data before and after VAD implant were available for 17 patients. VAD-associated sensitization developed in 35% of recipients. There were no differences between those sensitized in association with VAD support and non-sensitized patients with regard to age, gender, diagnosis, device type, extracorporeal membrane oxygenation use, or blood product exposure on VAD support. Black race predicted sensitization on VAD (p = 0.02). There were no differences in survival or rejection between groups.
VAD therapy was associated with the development of anti-HLA sensitization in 35% of recipients. Black race predicted sensitization, but there were no differences in overall survival or outcomes after OHT.
心室辅助装置（VAD）与抗人类白细胞抗原（HLA）抗体的形成或致敏有关。在儿科人群中，VAD 相关抗 HLA 致敏的发生率和影响尚未得到很好的研究。
对我院 1998 年至 2008 年期间所有接受 VAD 植入的患者进行回顾性分析。记录 VAD 植入前、植入后和原位心脏移植（OHT）后的面板反应性抗体（PRA）结果。比较 VAD 支持期间发生致敏（I 类和/或 II 类免疫球蛋白 G 抗体 PRA >或= 10%）的患者与非致敏患者的人口统计学、诊断、装置类型和 VAD 支持期间的血液制品暴露情况。还比较了两组患者 OHT 后的结果。
20 例患者（中位年龄 14.4 岁）开始接受 VAD 支持，75%存活至 OHT 或恢复。17 例患者有 VAD 植入前后的 PRA 数据。35%的受者发生了与 VAD 相关的致敏。在 VAD 支持相关致敏和非致敏患者之间，年龄、性别、诊断、装置类型、体外膜氧合使用或 VAD 支持期间血液制品暴露等方面均无差异。VAD 上的黑人种族预测致敏（p = 0.02）。两组患者在生存率或排斥反应方面无差异。
VAD 治疗与 35%受者抗 HLA 致敏的发展有关。黑人种族预测致敏，但总体生存率或 OHT 后结果无差异。
