Outcomes in pediatric cardiac transplantation with a positive HLA cross-match

Area of Science:

• Cardiology
• Transplantation Immunology

Background:

• Pediatric heart transplantation outcomes are often poorer in patients with high panel reactive antibody (PRA) or positive donor-recipient cross-match.
• This study evaluates outcomes in pediatric heart transplant recipients with a positive cross-match at a major pediatric center.

Purpose of the Study:

• To analyze the outcomes of pediatric heart transplant recipients with a positive cross-match.
• To compare rejection frequency and survival rates between positive and negative cross-match groups.

Main Methods:

• Retrospective review of pediatric heart transplant patients (1993-2009) with available cross-match data.
• Analysis of panel reactive antibody (PRA) levels and cross-match results.
• Comparison of rejection episodes and overall survival between positive and negative cross-match groups.

Main Results:

• Cross-match data were available for 92.4% of patients (242/262).
• A positive cross-match was observed in 55% of patients with PRA ≥10% (17/31), and none with PRA <10%.
• Patients with a positive cross-match had significantly higher rejection frequency in the first year post-transplant (1.69 vs. 0.96 episodes/pt year, p=0.014), but no difference after the first year.
• Overall survival was not significantly different between groups (median follow-up 4.5 years).

Conclusions:

• Pediatric heart transplantation in patients with a positive cross-match can achieve good medium-term survival.
• A higher frequency of early rejection is associated with positive cross-matches.
• Further investigation is required to identify specific patient subgroups with positive cross-matches who may experience adverse outcomes.