Daly Kevin P, Chandler Stephanie F, Almond Christopher S, Singh Tajinder P, Mah Helen, Milford Edgar, Matte Gregory S, Bastardi Heather J, Mayer John E, Fynn-Thompson Francis, Blume Elizabeth D
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Pediatr Transplant. 2013 Nov;17(7):661-9. doi: 10.1111/petr.12131. Epub 2013 Aug 6.
Sensitization to HLA is a risk factor for adverse outcomes after heart transplantation. Requiring a negative prospective CM results in longer waiting times and increased waitlist mortality. We report outcomes in a cohort of sensitized children who underwent transplant despite a positive CDC CM+ using a protocol of antibody depletion at time of transplant, followed by serial IVIG administration. All patients <21 yrs old who underwent heart transplantation at Boston Children's Hospital from 1/1998 to 1/2011 were included. We compared freedom from allograft loss, allograft rejection, and serious infection between CM+ and CM- recipients. Of 134 patients in the cohort, 33 (25%) were sensitized prior to transplantation and 12 (9%) received a CM+ heart transplant. Serious infection in the first post-transplant year was more prevalent in the CM+ patients compared with CM- patients (50% vs. 16%; p = 0.005), as was HD-AMR (50% vs. 2%; p < 0.001). There was no difference in freedom from allograft loss or any rejection. At our center, children transplanted despite a positive CM had acceptable allograft survival and risk of any rejection, but a higher risk of HD-AMR and serious infection.
对人类白细胞抗原（HLA）致敏是心脏移植术后不良结局的一个危险因素。要求前瞻性交叉配型（CM）结果为阴性会导致等待时间延长和等待名单上的死亡率增加。我们报告了一组致敏儿童的结局，这些儿童尽管交叉配型阳性（CDC CM+），但仍接受了移植，采用的方案是在移植时进行抗体清除，随后连续静脉注射免疫球蛋白（IVIG）。纳入了1998年1月至2011年1月在波士顿儿童医院接受心脏移植的所有21岁以下患者。我们比较了交叉配型阳性（CM+）和交叉配型阴性（CM-）受者在移植物丢失、移植物排斥和严重感染方面的情况。在该队列的134例患者中，33例（25%）在移植前致敏，12例（9%）接受了交叉配型阳性的心脏移植。与交叉配型阴性患者相比，交叉配型阳性患者在移植后第一年的严重感染更为普遍（50%对16%；p = 0.005），高敏抗体介导的排斥反应（HD-AMR）也是如此（50%对2%；p < 0.001）。在移植物丢失或任何排斥反应的发生率方面没有差异。在我们中心，尽管交叉配型阳性仍接受移植的儿童有可接受的移植物存活率和任何排斥反应的风险，但有更高的高敏抗体介导的排斥反应和严重感染风险。
