Hong Borah J, Delaney Meghan, Guynes Anthony, Warner Paul, McMullan David M, Kemna Mariska S, Boucek Robert J, Law Yuk M
From the *Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; †Puget Sound Blood Center, Seattle, Washington; ‡University of Washington School of Medicine, Seattle, Washington; §Division of Pediatric Cardiothoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington; and ¶Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
ASAIO J. 2014 May-Jun;60(3):317-21. doi: 10.1097/MAT.0000000000000053.
Human leukocyte antigen (HLA) sensitization of pediatric heart recipients increases their risk of rejection and graft loss. As more children are placed on mechanical circulatory support (MCS) as a bridge to transplant, the risk factors for development of sensitization warrant further study. A single-center retrospective review of 36 children who received MCS identified 22 patients supported with either extracorporeal membrane oxygenation (ECMO) (n = 15) or ECMO-ventricular assist device (VAD) (n = 7) with paired (pre-MCS/post-MCS) panel reactive antibodies (PRA) or only negative post-MCS PRAs. Four patients (18%) became sensitized post-MCS (one ECMO-only patient, three ECMO-VAD patients). No difference was found between sensitized and nonsensitized patients in terms of congenital heart disease versus primary cardiomyopathy (p = 0.096), duration of MCS (38 days vs. 14 days, p = 0.233), or volume of blood product transfusions (358.6 ml/kg vs. 612.7 ml/kg, p = not significant). By multivariable analysis, the association of sensitization with older age at MCS (p = 0.076) and history of homograft (p = 0.064) approached significance. Pediatric patients supported with MCS are at low risk of developing HLA sensitization. Diagnosis, MCS duration, and volume of transfused blood products do not appear to be associated with HLA sensitization, but there is a suggestion of an association with older age at MCS and history of a homograft.
小儿心脏移植受者的人类白细胞抗原（HLA）致敏会增加其排斥反应和移植物丢失的风险。随着越来越多的儿童接受机械循环支持（MCS）作为移植桥梁，致敏发生的危险因素值得进一步研究。一项对36例接受MCS的儿童进行的单中心回顾性研究，确定了22例接受体外膜肺氧合（ECMO）（n = 15）或ECMO-心室辅助装置（VAD）（n = 7）支持的患者，这些患者有配对的（MCS前/MCS后）群体反应性抗体（PRA）或仅MCS后PRA为阴性。4例患者（18%）在MCS后致敏（1例仅接受ECMO的患者，3例接受ECMO-VAD的患者）。在先天性心脏病与原发性心肌病方面（p = 0.096）、MCS持续时间（38天对14天，p = 0.233）或血液制品输注量（358.6 ml/kg对612.7 ml/kg，p = 无显著性差异），致敏患者与未致敏患者之间未发现差异。通过多变量分析，致敏与MCS时年龄较大（p = 0.076）和同种异体移植史（p = 0.064）的关联接近显著性。接受MCS支持的小儿患者发生HLA致敏的风险较低。诊断、MCS持续时间和输注的血液制品量似乎与HLA致敏无关，但提示与MCS时年龄较大和同种异体移植史有关。
