TY - JOUR
T1 - Pediatric heart transplantation across a positive crossmatch
T2 - First year results from the CTOTC-04 multi-institutional study
AU - the CTOTC-04 Investigators
AU - Webber, S.
AU - Zeevi, A.
AU - Mason, K.
AU - Addonizio, L.
AU - Blume, E.
AU - Dipchand, A.
AU - Shaddy, R.
AU - Feingold, B.
AU - Canter, C.
AU - Hsu, D.
AU - Mahle, W.
AU - Armstrong, B.
AU - Morrison, Y.
AU - Ikle, D.
AU - Diop, H.
AU - Odim, J.
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/9
Y1 - 2018/9
N2 - Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch–positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7% (CI: 2.7%, 13.3%), sensitized crossmatch positive 18.2% (CI: 2.3%, 51.8%), sensitized crossmatch negative 10.7% (CI: 5.7%, 18.0%), P =.2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.
AB - Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch–positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7% (CI: 2.7%, 13.3%), sensitized crossmatch positive 18.2% (CI: 2.3%, 51.8%), sensitized crossmatch negative 10.7% (CI: 5.7%, 18.0%), P =.2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.
KW - alloantibody
KW - clinical research/practice
KW - crossmatch
KW - heart transplantation/cardiology
KW - pediatrics
KW - rejection: antibody-mediated (ABMR)
UR - http://www.scopus.com/inward/record.url?scp=85047665633&partnerID=8YFLogxK
U2 - 10.1111/ajt.14876
DO - 10.1111/ajt.14876
M3 - Article
C2 - 29673058
AN - SCOPUS:85047665633
SN - 1600-6135
VL - 18
SP - 2148
EP - 2162
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 9
ER -