Abstract
(86) Impact of Anti-HLA Antibody Desensitization Strategies in Pediatric Heart Transplant Recipients: A PHTS-PHIS Linkage Analysis
The Journal of heart and lung transplantation, Vol.42(4 Suppl), pp.S48-S48
04/2023
DOI: 10.1016/j.healun.2023.02.102
Abstract
Human Leukocyte Antigen (HLA) sensitization can adversely impact heart transplant (HT) outcomes. We evaluated the effect of panel-reactive antibody (PRA) and desensitization (DS) strategies on outcomes of pediatric HT recipients in a multicenter cohort.
The Pediatric Heart Transplant Society (PHTS) registry was queried for all patients transplanted from January 2004-March 2021 and linked by date of birth, HT date, and center to the Pediatric Health Information System (PHIS). Class I and II PRA at listing, PRA at HT, underlying diagnosis, age, sex, and graft loss were abstracted from PHTS. Inpatient DS therapy and associated charges were assessed via PHIS. Listed patients were divided by PRA into Low (< median PRA) and High (≥ median PRA) cohorts for both Class I and II PRA. DS-related change in PRA category pre-HT as well as 10-year graft survival were recorded.
e linked 3,229 HT recipients (87.5% of total PHTS cohort) with PHIS (45% female, 51% congenital heart disease). Among those with PRA > 10%, median PRA for Class I and II was 36% and 48%, respectively. There were 223 High Class I and 191 High Class II patients. Of those with PRA > 10%, 10.8% received some DS therapy, including IVIg, rituximab, bortezomib and/or plasmapheresis pre-HT. DS therapies did not significantly alter absolute PRA or drive a change in PRA category from High to Low (p>0.05). Patients with Low PRAs at listing had greater 10-year graft survival than those with High PRA (p<0.05). DS therapy did not improve graft survival among patients who were highly sensitized at listing (Figure). Median pharmacy DS charges were $9.9K (IQR $3.9K-$28.4K).
Elevated PRA adversely impacts graft survival in pediatric HT recipients. Efficacy of DS remains questionable. In patients highly sensitized at listing, efforts at DS are not associated with improved outcomes. Given cost and morbidity associated with DS, careful assessment of risks and benefits for individual patients is warranted.
Details
- Title: Subtitle
- (86) Impact of Anti-HLA Antibody Desensitization Strategies in Pediatric Heart Transplant Recipients: A PHTS-PHIS Linkage Analysis
- Creators
- D. Nandi - Nationwide Children's HospitalR. Gajarski - Nationwide Children's HospitalH. Zhao - University of Alabama at BirminghamK. Tully - Nationwide Children's HospitalR. Cantor - University of Alabama at BirminghamB. Birnbaum - Children's Mercy HospitalS. Zangwill - Phoenix Children's HospitalR. Khan - University of IowaJ. Godown - Vanderbilt UniversityJ. Kirklin - University of Alabama at BirminghamJ. Friedland-Little - Seattle Children's Hospital
- Resource Type
- Abstract
- Publication Details
- The Journal of heart and lung transplantation, Vol.42(4 Suppl), pp.S48-S48
- DOI
- 10.1016/j.healun.2023.02.102
- ISSN
- 1053-2498
- eISSN
- 1557-3117
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 04/2023
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984773392102771
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