Hla-DR Mismatching Correlates With Early Cardiac Allograft Rejection, Incidence, and Graft Survival When High-Confidence-Level Serological DR Typing Is Used

Mattos, Angelo M. de; Head, M. A.; Everett, John P.; Hosenpud, Jeffrey D.; Hershberger, Ray E.; Çobanoğlu, Adnan; Ott, Gary Y.; Ratkovec, Ranae; Norman, Douglas J.

doi:10.1097/00007890-199402000-00026

Cited by 10 publications

(17 citation statements)

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“…However, evaluation of different recipient, donor, and treatment related factors in our cohort showed no significant influence on long term outcome. The incidence of HLA mismatch, which was shown to correlate with early allograft rejection incidence and graft survival by De Mattos et al and Smith et al ,30 31 was not different in our survivor and non-survivor groups, though complete data were only available in 73 patients. We only found a positive trend in patients with dilated cardiomyopathy as the underlying disease, which might reflect the younger age of the recipients (39.1 (12.2) v 48.2 (5.8) years), less concomitant disease, and better general physical condition in this subgroup.…”

Section: Discussionmentioning

confidence: 46%

Ten year survival after heart transplantation: palliative procedure or successful long term treatment?

Fraund

Pethig

Franke

et al. 1999

Heart

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Objective-To investigate the long term outcome and prognostic factors after heart transplantation. Setting-University hospital. Subjects-120 heart transplant patients (98 male, 22 female; underlying disease: dilated cardiomyopathy in 69, coronary artery disease in 42, miscellaneous in nine) who had undergone heart transplantation between October 1984 and October 1987. Immunosuppressive treatment was comparable in all patients and rejection episodes were treated in a uniform manner. Methods-Functional status, quality of life, and potential predictors for long term survival were investigated. Results-Actuarial survival rates were 65% at five years and 48% at 10 years; 58 patients survived > 10 years. The major causes of death were cardiac allograft vasculopathy (39%), acute rejection (18%), infection (11%), and malignancy (11%). Long term survivors had good exercise tolerance assessed by the New York Heart Association classification: 47 (81%) in grade I/II; 11 (19%) in grade III/IV. Echocardiography showed good left ventricular function in 48 patients. On angiography, severe allograft vasculopathy was present in only 16 patients (28%). Renal function was only slightly impaired, with mean (SD) serum creatinine of 148.5 (84.9) µmol/l. Multiple potential predictors of long term survival were analysed but none was found useful. Conclusions-Heart transplantation represents a valuable form of treatment. Survival for more than 10 years with a good exercise tolerance and acceptable side eVects from immunosuppression can be achieved in about 50% of patients. (Heart 1999;82:47-51)

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Section: Discussionmentioning

confidence: 46%

Ten year survival after heart transplantation: palliative procedure or successful long term treatment?

Fraund

Pethig

Franke

et al. 1999

Heart

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“…Screening of references did not provide any additional articles. Fifty‐seven studies were included in the final analysis . Only twelve studies were of multicenter design .…”

Section: Resultsmentioning

confidence: 99%

“…The relationship between HLA matching and outcome in heart transplantation has been the subject of several studies, most of which were published before 2000 . Due to limitation in ischemic time, extensive HLA antigen polymorphism, donor shortages, and logistics, transplantation between HLA‐identical donor–recipient pairs and well‐matched transplants has not been possible in many cases .…”

Section: Introductionmentioning

confidence: 99%

Human leukocyte antigen matching in heart transplantation: systematic review and meta-analysis

2014

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SummaryAllocation of donors with regard to human leukocyte antigen (HLA) is controversial in heart transplantation. This paper is a systematic review and meta-analysis of the available evidence. PubMed, Embase, and the Cochrane Library were searched systematically for studies that addressed the effects of HLA matching on outcome after heart transplantation. Fifty-seven studies met the eligibility criteria. 34 studies had graft rejection as outcome, with 26 of the studies reporting a significant reduction in graft rejection with increasing degree of HLA matching. Thirteen of 18 articles that reported on graft failure found that it decreased significantly with increasing HLA match. Two multicenter studies and nine single-center studies provided sufficient data to provide summary estimates at 12 months. Pooled comparisons showed that graft survival increased with fewer HLA-DR mismatches [0-1 vs. 2 mismatches: risk ratio (RR) = 1.09 (95% confidence interval (CI): 1.01-1.19; P = 0.04)]. Having fewer HLA-DR mismatches (0-1 vs. 2) reduced the incidence of acute rejection ; P = 0.04)]. Despite the considerable heterogeneity between studies, the short observation time, and older data, HLA matching improves graft survival in heart transplantation. Prospective HLA-DR matching is clinically feasible and should be considered as a major selection criterion.

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“…Despite the success of this LVAD-bridging to transplant, many mechanically supported heart transplant candidates develop circulating anti-HLA antibodies with potential donor reactivity, manifest as an elevation of the PRA (2, 3, 4). Having an increased PRA has been shown to increase transplant waiting times (15) and leads to adverse clinical outcomes even after a crossmatch compatible transplant (7, 8). …”

Section: Discussionmentioning

confidence: 99%

Prior Human Leukocyte Antigen-Allosensitization and Left Ventricular Assist Device Type Affect Degree of Post-implantation Human Leukocyte Antigen-Allosensitization

Drakos

Kfoury

Kotter

et al. 2009

The Journal of Heart and Lung Transplantation

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Background Temporary use of left ventricular assist devices (LVADs) prior to heart transplantation has been associated with formation of antibodies directed against human leukocyte antigens (HLA), often referred to as sensitization. Identifying specific factors that might predispose patients to form HLA-specific antibodies after LVAD implantation may facilitate the development of strategies to prevent high degree of sensitization. We investigated whether prior sensitization or LVAD type affected the degree of post-implantation sensitization. Methods We reviewed the records of consecutive HeartMate (HM) I and HM II LVAD patients. Panel reactive antibody (PRA) was assessed, either with antiglobulin cytotoxicity or flow cytometry, prior to LVAD implantation and biweekly thereafter. Sensitization was defined as PRA >10% and high degree sensitizization was defined as a PRA >90%. Results Sixty-four patients underwent implantation with a HM I LVAD and 11 patients with a HM II LVAD as a bridge to transplant. Among the HM I patients, 10 (16%) were sensitized before LVAD implantation (HM I-SENSITIZED), averaging a PRA of 50±35 %, and 54 (84%) were not (HM I-NON-SENSITIZED). Nine of 10 HM I-SENSITIZED patients (90%) became highly sensitized (PRA>90%) compared to only 9/54 HM I-NON-SENSITIZED patients (16.7%) (p<0.001). Despite similar duration of mechanical support, the PRA remained elevated (>90%) in all but 1 of the highly sensitized pts in HM I-SENSITIZED (8/9, 88.9%), compared to only 5/9 (55.6%) of the highly sensitized pts in HM I-NON-SENSITIZED. In the rest of the HM I-SENSITIZED highly sensitized pts PRA declined from a peak value of 93±4% to 55±15% (p= 0.01). Among the HM II patients, 1 (9 %) was sensitized before LVAD implantation (PRA 40%) and 10 (91%) were not sensitized. The sensitized HM II patient did not become highly sensitized but did moderately increase the PRA to 80%. No other HM II patient became sensitized after implantation. Thus, fewer HM II patients became sensitized when compared to the HM I patients [1/11 (9%) vs 29/64 (45%); p=0.04]. Conclusion Pre-sensitized patients are at higher risk for becoming and remaining highly HLA-allosensitized after LVAD implantation. Furthermore, HeartMate II LVAD appears to cause less sensitization than HeartMate I LVAD.

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Hla-DR Mismatching Correlates With Early Cardiac Allograft Rejection, Incidence, and Graft Survival When High-Confidence-Level Serological DR Typing Is Used

Cited by 10 publications

References 0 publications

Ten year survival after heart transplantation: palliative procedure or successful long term treatment?

Ten year survival after heart transplantation: palliative procedure or successful long term treatment?

Human leukocyte antigen matching in heart transplantation: systematic review and meta-analysis

Prior Human Leukocyte Antigen-Allosensitization and Left Ventricular Assist Device Type Affect Degree of Post-implantation Human Leukocyte Antigen-Allosensitization

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