Related Experiment Video

Updated: Apr 20, 2026

Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
08:15

Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion

Published on: November 28, 2025

1.1K

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

Alfred Asante-Korang1, Ernest K Amankwah2, Mayra Lopez-Cepero3

  • 1Divisions of Pediatric Cardiology.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|December 3, 2014
PubMed

Insights

Aggressive desensitization may improve outcomes for pediatric heart transplant recipients with high levels of pre-formed anti-human leukocyte antigen antibodies (PRA). This strategy showed promising, though not statistically significant, reductions in rejection and mortality in high PRA patients.

Area of Science:

  • Pediatric Cardiology
  • Transplant Immunology
  • Immunosuppression Strategies

Background:

  • Children with pre-formed anti-human leukocyte antigen (HLA) antibodies (PRA) undergoing orthotopic heart transplantation (OHT) face increased risks of rejection, coronary artery vasculopathy (CAV), and mortality.
  • A program initiated aggressive desensitization protocols in 2005, including plasmapheresis, IVIg, pulse cytoxan, and rituximab, to mitigate these risks.
  • This study aimed to evaluate the effectiveness of this desensitization strategy by comparing outcomes in pediatric OHT recipients with high PRA (>10%) versus low PRA (≤10%).

Purpose of the Study:

  • To compare the outcomes of pediatric orthotopic heart transplantation (OHT) in recipients with high pre-transplant anti-human leukocyte antigen antibody levels (PRA >10%) versus those with low PRA (≤10%).
  • To assess the impact of an aggressive desensitization protocol on rejection rates, mortality, and coronary artery vasculopathy (CAV) in these patient groups.

Main Methods:

  • Retrospective analysis of 70 consecutive pediatric OHT patients between January 2005 and July 2013.
  • Patients were categorized into high PRA (>10%) and low PRA (≤10%) groups.
  • Outcomes analyzed included rejection incidence, 30-day and overall mortality, freedom from significant rejection, and CAV.

Main Results:

  • Fourteen patients (20%) had high PRA, and 56 (80%) had low PRA.
  • Aggressive desensitization led to a significant decrease in PRA values.
  • The high PRA group exhibited lower 30-day and overall mortality and reduced rates of rejection and CAV, though these differences were not statistically significant. Kaplan-Meier survival analysis showed no significant difference in survival between groups. Survival rates improved significantly for sensitized patients post-2005 compared to pre-2005.

Conclusions:

  • No significant differences in outcomes were observed between high and low PRA pediatric OHT recipients.
  • Preliminary findings suggest that aggressive desensitization protocols may improve OHT outcomes for patients with high PRA.
  • A larger study is recommended to confirm these findings and validate the efficacy of desensitization strategies in this population.
Abstract

Keywords:
antibodieshuman leukocyte antigenpediatric, heartsensitizationtransplant

More Related Videos

A Modified Murine Heterotopic Heart Transplant Protocol Matching Contemporary Standards of Aseptic Technique, Anesthesia, and Analgesia12:40

A Modified Murine Heterotopic Heart Transplant Protocol Matching Contemporary Standards of Aseptic Technique, Anesthesia, and Analgesia

Published on: September 28, 2022

2.3K
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft08:30

A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft

Published on: February 14, 2022

3.4K

Related Concept Videos

Tissue Transplantation01:24

Tissue Transplantation

Tissue transplantation is a significant medical procedure involving the transfer of cells, tissues, or organs from a donor to a recipient, with the primary aim of restoring lost functions. This procedure is crucial in treating a broad spectrum of diseases, including kidney diseases, liver failure, heart disease, and certain types of cancers.
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
1.3K
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
724
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
594