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Does histocompatibility affect homograft valve function after the Ross procedure?

J F Bechtel1, C Bartels, C Schmidtke

  • 1Clinic for Cardiac Surgery, Institute for Immunology and Transfusion Medicine, Medical University of Luebeck, Luebeck, Germany.

Circulation
|September 25, 2001
PubMed
Summary
This summary is machine-generated.

Cryopreserved pulmonary homografts in the Ross procedure can trigger an immune response. While pressure gradients increased post-surgery, human leukocyte antigen (HLA) mismatches did not impact valve function in this study.

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Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Transplantation

Background:

  • Homograft valves are immunogenic, but their impact on valve function remains unclear.
  • The Ross procedure utilizes cryopreserved pulmonary homografts.
  • Histoincompatibility and recipient immune response are key areas of investigation.

Purpose of the Study:

  • To prospectively evaluate the relationship between histoincompatibility (human leukocyte antigen [HLA] mismatches) and recipient immune response (anti-HLA antibodies).
  • To assess the impact of these factors on echocardiographic parameters of homograft valve function after the Ross procedure.

Main Methods:

  • Prospective study of 26 patients undergoing the Ross procedure with cryopreserved pulmonary homografts.
  • Human leukocyte antigen (HLA) typing of donor and recipient for HLA-A, HLA-B, and HLA-DR.
  • Echocardiographic assessment of transhomograft pressure gradients and regurgitation at a mean follow-up of 15 months.

Main Results:

  • 54% of patients developed donor-specific anti-HLA class I antibodies.
  • A significant increase in transhomograft pressure gradients was observed.
  • Neither the degree of HLA mismatch nor antibody status correlated with homograft valve function.
  • Smaller homograft size and younger recipient age were associated with increased pressure gradients.

Conclusions:

  • Cryopreserved pulmonary homografts can induce a specific humoral immune response.
  • Increased transhomograft pressure gradients were noted within 15 months post-surgery.
  • No relationship was found between histoincompatibility and the observed increase in pressure gradients during this follow-up period.