Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR 72202, USA.
Transplantation. 2013 Jun 27;95(12):1542-7. doi: 10.1097/TP.0b013e3182925242.
Ventricular assist devices (VADs) are increasingly being used in pediatric patients to provide long-term cardiac support. One potential complication of VAD therapy is the development of antibodies directed against human leukocyte antigens (HLA). This phenomenon has not been well described with the Berlin Heart EXCOR VAD, the most commonly used VAD in pediatric patients.
The records of all pediatric patients undergoing VAD support using the Berlin Heart device at our institution between April 2005 and August 2011 were reviewed retrospectively. Demographic and clinical data regarding the VAD course were collected. Assessment of anti-HLA antibodies was performed using Luminex, and antibodies were quantified using mean fluorescence intensity (MFI). Assessment for anti-HLA antibodies was performed before VAD implantation and in serial fashion after VAD implantation. Clinically significant anti-HLA antibodies (sensitization) were defined by an MFI of more than 1000.
Thirty-six patients were supported with the Berlin Heart VAD; 13 met inclusion criteria. The majority (85%) carried the diagnosis of dilated cardiomyopathy. Evidence of sensitization pre-VAD was found in 69%; new-onset sensitization (the development of new antibodies on VAD) occurred in 69%. All patients survived to transplantation. In two patients, the retrospective crossmatch was positive, but only in one patient was the crossmatch positive for antibodies formed while on VAD.
Using Luminex and MFI quantification, anti-HLA antibodies are common before VAD implantation in pediatric patients. While on VAD support, new anti-HLA antibodies formed in a majority, but the immediate impact of these antibodies appears to be limited.
心室辅助装置（VAD）越来越多地用于儿科患者，以提供长期心脏支持。VAD 治疗的一个潜在并发症是针对人类白细胞抗原（HLA）的抗体的发展。这种现象在柏林心脏 EXCOR VAD 中尚未得到很好的描述，该装置是儿科患者最常用的 VAD。
回顾性分析了 2005 年 4 月至 2011 年 8 月期间在我院接受柏林心脏装置 VAD 支持的所有儿科患者的记录。收集了有关 VAD 病程的人口统计学和临床数据。使用 Luminex 评估抗 HLA 抗体，并使用平均荧光强度（MFI）定量抗体。在 VAD 植入前和 VAD 植入后进行了抗 HLA 抗体的评估。具有临床意义的抗 HLA 抗体（致敏）的定义为 MFI 大于 1000。
36 例患者接受了柏林心脏 VAD 支持，其中 13 例符合纳入标准。大多数（85%）患者携带扩张型心肌病的诊断。VAD 前发现致敏证据的占 69%；新出现的致敏（在 VAD 上形成新的抗体）发生率为 69%。所有患者均存活至移植。在 2 例患者中，回顾性交叉配型呈阳性，但只有 1 例患者在 VAD 上形成的抗体交叉配型呈阳性。
使用 Luminex 和 MFI 定量，儿科患者在 VAD 植入前就存在抗 HLA 抗体。在 VAD 支持期间，大多数患者形成了新的抗 HLA 抗体，但这些抗体的直接影响似乎有限。
