دورية أكاديمية
أعرض في EDS

Impact of a positive crossmatch on pediatric heart transplant outcomes.

التفاصيل البيبلوغرافية
العنوان: Impact of a positive crossmatch on pediatric heart transplant outcomes.
المؤلفون: Milligan C; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Williams RJ; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Singh TP; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Bastardi HJ; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts., Esteso P; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Almond CS; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California., Gauvreau K; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts., Daly KP; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: kevin.daly@childrens.harvard.edu.
المصدر: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2024 Jun; Vol. 43 (6), pp. 963-972. Date of Electronic Publication: 2024 Feb 27.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 9102703 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-3117 (Electronic) Linking ISSN: 10532498 NLM ISO Abbreviation: J Heart Lung Transplant Subsets: MEDLINE
أسماء مطبوعة: Publication: 1999- : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby-Year Book, Inc., c1991-
مواضيع طبية MeSH: Heart Transplantation* , Graft Rejection*/immunology , Graft Rejection*/epidemiology , Graft Survival*, Humans ; Child ; Male ; Female ; Child, Preschool ; Retrospective Studies ; Histocompatibility Testing ; Adolescent ; Infant ; Tissue Donors
مستخلص: Background: Pediatric heart transplant (HT) candidates experience high waitlist mortality due to a limited donor pool that is constrained in part by anti-HLA sensitization. We evaluated the impact of CDC and Flow donor-specific crossmatch (XM) results on pediatric HT outcomes.
Methods: All pediatric HTs between 1999 and 2019 in the OPTN database were included. Donor-specific XM results were sub-categorized based on CDC and Flow results. Primary outcomes were treated rejection in the first year and time to death or allograft loss. Propensity scores were utilized to adjust for differences in baseline characteristics.
Results: A total of 4,695 pediatric HT patients with T-cell XM data were included. After propensity score adjustment, a positive T-cell CDC-XM was associated with 2 times higher odds of treated rejection (OR 2.29 (1.56, 3.37)) and shorter time to death/allograft loss (HR 1.50 (1.19, 1.88)) compared to a negative Flow-XM. HT recipients who were Flow-XM positive with negative/unknown CDC-XM did not have higher odds of rejection or shorter time to death/allograft loss. An isolated positive B-cell XM was also not associated with worse outcomes. Over the study period XM testing shifted from CDC- to Flow-based assays.
Conclusions: A positive donor-specific T-cell CDC-XM was associated with rejection and death/allograft loss following pediatric HT. This association was not observed with a positive T-cell Flow-XM or B-cell XM result alone. The shift away from performing the CDC-XM may result in loss of important prognostic information unless the clinical relevance of quantitative Flow-XM results on heart transplant outcomes is systematically studied.
(Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: T32 HL007572 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: crossmatch; histocompatibility; outcomes research; pediatric heart transplant; propensity scores; registries; rejection
تواريخ الأحداث: Date Created: 20240229 Date Completed: 20240513 Latest Revision: 20240515
رمز التحديث: 20240515
مُعرف محوري في PubMed: PMC11090719
DOI: 10.1016/j.healun.2024.02.1457
PMID: 38423415
قاعدة البيانات: MEDLINE
الوصف
تدمد:1557-3117
DOI:10.1016/j.healun.2024.02.1457