Risk factors for acute rejection after pediatric heart transplantation

Cardiac Transplant Outcomes in Pediatric Patients with Pre-formed Anti-Human Leukocyte Antigen Antibodies and/or Positive Retrospective Crossmatch

“…11 However, even using the more commonly applied standard for (PRA positivity as 10%), a positive PRA was still not associated with an increased risk of graft loss. This finding differs from results of other pediatric studies 20,22 and larger adult studies 3,7 but is consistent with a recent large pediatric study. 21 We believe this negative finding about the utility of PRA may partly relate to the insensitive cytotoxicity assay used before mid-2003, which may simply have missed patients who would have been identified as positive with the flow cytometric assay.…”

Survival in Allosensitized Children After Listing for Cardiac Transplantation

“…Although the current study did not assess acute rejection profiles by pre-transplant sensitization status, our group previously demonstrated that children with adverse first-year rejection profiles more commonly had pre-transplant anti-HLA antibodies detected by ELISA. 22 An association with acute rejection was also shown in separate analyses of pre-transplant PRA data by Chartrand et al 23 and by Mahle et al 24 Mahle and colleagues reported the experience of the Pediatric Heart Transplant Study (PHTS), a multi-institutional North American research consortium. 24 They reported that an elevated PRA at listing was associated with longer time to transplantation and higher risk of death while waiting, as was found in the current study.…”

“…[22][23][24][25][26] Focused study of the pediatric age group is important due to several differences from the adult cardiac transplant population including: listing diagnoses; immunologic maturity; use of homograft material in prior congenital heart disease repairs; and wait list times and survival. Although the current study did not assess acute rejection profiles by pre-transplant sensitization status, our group previously demonstrated that children with adverse first-year rejection profiles more commonly had pre-transplant anti-HLA antibodies detected by ELISA.…”

Utility of Post-Transplant Anti-HLA Antibody Measurements in Pediatric Cardiac Transplant Recipients

“…In the only report of PRAs in the pediatric population, Chartrand et al reported a trend toward more rejection episodes in 8 patients with pre-transplant anti-HLA antibodies, 13 although no distinction was made between Class I and Class II antibodies in their study and the results were limited by the small sample size.…”

“…A small study series reported a trend toward more rejection episodes in pediatric patients with pre-transplant anti-HLA antibodies. 13 No study has examined the significance of posttransplant PRAs in the pediatric population. The aim of this study was to evaluate the association between posttransplant anti-HLA Class I and II antibodies and survival, TCAD incidence and rejection rate in pediatric cardiac transplant recipients.…”