Outcomes in highly sensitized pediatric heart transplant patients using current management strategies

Alfred Asante-Korang, Ernest K. Amankwah, Mayra Lopez-Cepero, Jeremy Ringewald, Jennifer Carapellucci, Diane Krasnopero, Alex Berg, James Quintessenza, Jeffrey P. Jacobs

Research output: Contribution to journalArticle

Abstract

Background Previous studies have suggested that children with pre-formed anti-HLA antibodies (PRA) undergoing orthotopic heart transplantation (OHT) have increased risk for rejection, coronary artery vasculopathy (CAV) and death. In 2005, our program started utilizing aggressive desensitization (including plasmapheresis, IVIg, pulse cytoxan and rituximab) with the goal of improving outcomes for these patients. The purpose of this study was to compare outcomes with this new strategy in recipients with pre-OHT high PRA (>10%) vs low PRA <&10%). Methods A retrospective study of 70 consecutive pediatric OHT patients was undertaken between January 2005 and July 2013 to identify patients with pre-OHT PRA >10% (high PRA), or PRA <;10% (low PRA). Demographic/data information and detailed post-OHT outcomes, including rejection, 30-day and overall mortality, freedom from significant rejection, and CAV, were analyzed. Results Fourteen (20%) patients had high PRA and 56 (80%) did not. There was a significant decrease in PRA values before and after desensitization. Thirty-day and overall mortality and the proportion of patients with rejections or CAV were lower in the high PRA group, although the difference was not statistically significant. Kaplan-Meier survival analysis revealed no significant difference in survival between the two groups. There was a significant difference in survival in our sensitized patients before 2005 vs after 2005. Conclusions We identified no significant differences in outcomes between high or low PRA patients. These preliminary findings may suggest improvement in OHT outcomes for high PRA patients as a result of aggressive desensitization. A larger study is warranted to confirm these findings.

Original languageEnglish (US)
Pages (from-to)175-181
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2015

Keywords

  • antibodies
  • heart
  • human leukocyte antigen
  • pediatric
  • sensitization
  • transplant

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Asante-Korang, A., Amankwah, E. K., Lopez-Cepero, M., Ringewald, J., Carapellucci, J., Krasnopero, D., Berg, A., Quintessenza, J., & Jacobs, J. P. (2015). Outcomes in highly sensitized pediatric heart transplant patients using current management strategies. Journal of Heart and Lung Transplantation, 34(2), 175-181. https://doi.org/10.1016/j.healun.2014.09.027