Development of Human Leukocyte Antigen (HLA) Antibodies Against Vascular Homograft Donor in Pediatric Heart Transplant Recipients

Autor: Jaana Pihkala, Alireza Raissadati, Timo Jahnukainen, Jouni Lauronen, Hannu Jalanko, Juha Puntila, Tommi Pätilä, Ilkka Mattila, Elisa Ylinen, Jukka T. Salminen
Přispěvatelé: HUS Children and Adolescents, Children's Hospital, University of Helsinki, Lastentautien yksikkö, Clinicum, Lastenkirurgian yksikkö
Rok vydání: 2019
Předmět:
Graft Rejection
Male
IMPACT
medicine.medical_treatment
CHILDREN
030204 cardiovascular system & hematology
030230 surgery
Gastroenterology
0302 clinical medicine
Isoantibodies
HLA Antigens
NOMENCLATURE
Hla antibodies
Child
Heart transplantation
biology
Graft Survival
General Medicine
3. Good health
HEMODIALYSIS ACCESS
surgical procedures
operative
medicine.anatomical_structure
REJECTION
Child
Preschool
WORKING FORMULATION
Cohort
Female
Antibody
Artery
medicine.medical_specialty
Adolescent
Allosensitization
INTERNATIONAL SOCIETY
ALLOGRAFT
Human leukocyte antigen
03 medical and health sciences
Internal medicine
Cadaver
medicine
Humans
Retrospective Studies
Original Paper
Transplantation
VALVES
business.industry
Infant
Retrospective cohort study
3126 Surgery
anesthesiology
intensive care
radiology
body regions
Antibody Formation
biology.protein
Heart Transplantation
Vascular Grafting
IMPLANTATION
business
Zdroj: Annals of Transplantation
ISSN: 2329-0358
DOI: 10.12659/aot.917232
Popis: Background: The appearance of human leukocyte antigen (HLA) antibodies after solid organ transplantation predisposes recipients to graft dysfunction. In theory, vascular homografts, which are widely used in children with congenital heart defects, may cause allosensitization. Material/Methods: In this single-center retrospective study, the presence of pre-existing HLA antibodies in pediatric heart trans- plant (HTx) recipients with a vascular homograft was evaluated in a cohort of 12 patients. HLA antibodies were screened before and after HTx and positive screening results were confirmed and identified using the Luminex (R) single antigen bead method. Endomyocardial biopsies (EMB) and coronary angiography studies were re-evaluated to assess the prevalence of acute rejections and coronary artery change in these patients. Results: At the time of HTx, 8 patients (67%) had HLA antibodies detected by the Luminex assay, none of which were heart donor specific (DSA). All patients had negative leukocyte crossmatch. One patient developed DSAs against homograft donor prior to HTx. After the HTx, 5 patients (42%) developed DSAs against the heart donor and 4 patients (40%) against the homograft donor. In 2 patients (17%), the antibodies were against both heart and homograft donors. The rejection rate or prevalence of coronary artery vasculopathy did not differ significantly between the homograft cohort and our historical controls. Conclusions: Our results suggest that the prevalence of DSAs against homograft donor prior to HTx is relatively rare. However, almost half of the patients developed DSAs against homograft post-HTx. The clinical importance of these antibodies warrants further studies.
Databáze: OpenAIRE
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