Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex 77030, USA.
J Thorac Cardiovasc Surg. 2010 Sep;140(3):694-9, 699.e1-2. doi: 10.1016/j.jtcvs.2010.04.009. Epub 2010 May 27.
Controversy exists regarding the importance of circulating antibodies as determined by panel-reactive antibody screening as a risk factor for graft failure in pediatric patients undergoing heart transplantation. This study sought to determine the association of elevated anti-human leukocyte antibodies with long-term survival in pediatric heart transplant patients.
The United Network for Organ Sharing registry was queried for pediatric patients (aged < 18 years at listing) with panel-reactive antibody levels obtained before heart transplantation from 1987 through 2004. Survival analysis methods were used to assess the association of elevated panel-reactive antibodies with long-term graft and patient survival.
Panel-reactive antibodies were obtained before transplantation from 3534 patients, median age 4 years (interquartile range 0-12 years). Most, 2711 (77%), had no detectable panel-reactive antibodies, 436 (12%) had panel-reactive antibodies of 1% to 10%, and 387 (11%) had panel-reactive antibodies greater than 10%. Patients with panel-reactive antibodies greater than 10% were more likely to be older (P = .04), have congenital heart disease (P < .001), and have a longer wait list time (P = .006). Patients with panel-reactive antibodies greater than 10% had significantly worse graft survival and patient survival than did patients with undetectable panel-reactive antibodies and panel-reactive antibodies of 1% to 10% (P < .05 for all). Controlling for confounding variables, elevated panel-reactive antibodies as a continuous variable and panel-reactive antibodies greater than 10% as a categorical variable were independently associated with decreased graft survival (P = .04 and P = .02, respectively).
Elevated panel-reactive antibodies are independently associated with worse long-term graft survival in pediatric patients undergoing heart transplantation. Further study is needed to determine the optimal management of this high-risk population.
通过面板反应性抗体筛查确定循环抗体的重要性，作为儿科患者心脏移植后移植物失败的风险因素，这方面存在争议。本研究旨在确定抗人类白细胞抗体升高与儿科心脏移植患者长期生存的关系。
通过器官共享联合网络（UNOS）注册中心，对 1987 年至 2004 年期间接受心脏移植的儿科患者（登记时年龄<18 岁）进行面板反应性抗体水平检测。采用生存分析方法评估升高的面板反应性抗体与长期移植物和患者生存的关系。
共从 3534 例患者中获得了移植前的面板反应性抗体，中位年龄为 4 岁（四分位间距为 0-12 岁）。大多数患者（2711 例，77%）无检测到的面板反应性抗体，436 例（12%）有 1%-10%的面板反应性抗体，387 例（11%）有大于 10%的面板反应性抗体。面板反应性抗体大于 10%的患者年龄更大（P=0.04）、患有先天性心脏病（P<0.001）、等待时间更长（P=0.006）。与无检测到的面板反应性抗体和 1%-10%的面板反应性抗体的患者相比，面板反应性抗体大于 10%的患者移植物存活率和患者存活率明显更差（所有 P<0.05）。控制混杂因素后，作为连续变量的升高的面板反应性抗体和作为分类变量的面板反应性抗体大于 10%均与移植物存活率降低独立相关（P=0.04 和 P=0.02）。
升高的面板反应性抗体与儿科患者心脏移植后长期移植物存活率降低独立相关。需要进一步研究以确定这一高危人群的最佳管理方法。
