Incidence, characterization, and impact of newly detected donor-specific anti-HLA antibody in the first year after pediatric heart transplantation: A report from the CTOTC-04 study
| Autor: | David Ikle, Jonah Odim, Anne I. Dipchand, Yvonne Morrison, A. Zeevi, Brian Armstrong, S. Webber, Brian Feingold, Elizabeth D. Blume, Helena Diop, William T. Mahle, Robert E. Shaddy, Charles E. Canter, W. Zuckerman, Kristen L Mason, Carol Bentlejewski, Jacqueline M. Lamour |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Adolescent Acute cellular rejection Population 030232 urology & nephrology Anti-HLA antibody 030230 surgery Article 03 medical and health sciences Young Adult 0302 clinical medicine Postoperative Complications HLA Antigens Isoantibodies Risk Factors Internal medicine Immunology and Allergy Medicine Humans Pharmacology (medical) Prospective Studies education Child Transplantation education.field_of_study biology business.industry Incidence (epidemiology) Histocompatibility Testing Incidence Graft Survival Infant Prognosis Tissue Donors Survival Rate surgical procedures operative Child Preschool Cohort biology.protein Heart Transplantation Female Pediatric heart transplantation Antibody business Follow-Up Studies |
| Zdroj: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 18(9) |
| ISSN: | 1600-6143 |
| Popis: | Data on the clinical importance of newly detected donor-specific anti-HLA antibodies (ndDSAs) after pediatric heart transplantation are lacking despite mounting evidence of the detrimental effect of de novo DSAs in solid organ transplantation. We prospectively tested 237 pediatric heart transplant recipients for ndDSAs in the first year posttransplantation to determine their incidence, pattern, and clinical impact. One-third of patients developed ndDSAs; when present, these were mostly detected within the first 6 weeks after transplantation, suggesting that memory responses may predominate over true de novo DSA production in this population. In the absence of preexisting DSAs, patients with ndDSAs had significantly more acute cellular rejection but not antibody-mediated rejection, and there was no impact on graft and patient survival in the first year posttransplantation. Risk factors for ndDSAs included common sensitizing events. Given the early detection of the antibody response, memory responses may be more important in the first year after pediatric heart transplantation and patients with a history of a sensitizing event may be at risk even with a negative pretransplantation antibody screen. The impact on late graft and patient outcomes of first-year ndDSAs is being assessed in an extended cohort of patients. |
| Databáze: | OpenAIRE |
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