Das B B, Pruitt E, Molina K, Ravekes W, Auerbach S, Savage A, Knox L, Kirklin J K, Naftel D C, Hsu D
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA.
Pediatr Transplant. 2018 Feb;22(1). doi: 10.1111/petr.13087. Epub 2017 Nov 16.
Data from patients in the Pediatric Heart Transplant Study (PHTS) registry transplanted between 2010 and 2014 were analyzed to determine the association between HLA antibody (PRA) determined by SPA using Luminex or flow cytometry with a positive retrospective cross-match and the post-transplant outcomes of acute rejection and graft survival. A total of 1459 of 1596 (91%) recipients had a PRA reported pretransplant; 26% had a PRA > 20%. Patients with a PRA > 20% were more likely to have CHD, prior cardiac surgery, ECMO support at listing, and waited longer for transplantation than patients with a PRA <20%. Patients with higher PRA% determined by SPA were predictive of a positive retrospective cross-match determined by flow cytometric method (P < .001). A PRA > 50% determined by SPA was independently associated with worse overall graft survival after first month of transplant in both unadjusted and adjusted for all other risk factors. In this large multicenter series of pediatric heart transplant recipients, an elevated PRA determined by SPA remains a significant risk factor in the modern era.
分析2010年至2014年间在儿科心脏移植研究（PHTS）登记处接受移植的患者数据，以确定采用Luminex或流式细胞术通过固相分析法（SPA）测定的HLA抗体（PRA）与阳性回顾性交叉配型之间的关联，以及移植后急性排斥反应和移植物存活的结果。1596名受者中有1459名（91%）在移植前报告了PRA；26%的患者PRA>20%。与PRA<20%的患者相比，PRA>20%的患者更有可能患有冠心病、既往心脏手术史、登记时接受体外膜肺氧合（ECMO）支持，且等待移植的时间更长。通过SPA测定的较高PRA%可预测通过流式细胞术方法确定的阳性回顾性交叉配型（P<.001）。在未调整和调整所有其他风险因素的情况下，通过SPA测定的PRA>50%与移植后第一个月后总体移植物存活较差独立相关。在这个大型多中心儿科心脏移植受者系列中，通过SPA测定的PRA升高在现代仍然是一个重要的危险因素。
