Outcomes of Cardiac Transplantation in Highly Sensitized Pediatric Patients

摘要

Despite aggressive immunosuppressive therapy, pediatric orthotopic heart transplant (OHT) candidates with elevated pre-transplant panel reactive antibody (PRA) carry an increased risk of rejection and early graft failure following transplantation. This study has aimed to more specifically evaluate the outcomes of transplant candidates stratified by PRA values. Records of pediatric patients listed for OHT between April 2004 and July 2008 were reviewed (n = 101). Survival analysis was performed comparing patients with PRA 25 to those with PRA 25, as well as patients with PRA 80 and PRA 80. Patients with PRA 25 had decreased survival compared with those with PRA 25 after listing (P = 0.004). There was an even greater difference in survival between patients with PRA 80 and those with PRA 80 (P = 0.002). Similar analyses for the patients who underwent successful transplantation showed no significant difference in post-transplant survival between patients with a pre-transplant PRA 25 and those with PRA 25 (P = 0.23). A difference approaching significance was noted for patients with PRA 80 compared with PRA 80 (P = 0.066). Patients with significantly elevated pre-transplant PRAs at the time of listing have a significantly worse outcome compared to those with moderately increased PRA values or non-sensitized patients. Further study is necessary to guide physician and family treatment decisions at the time of listing.