Inclusive ABO-Incompatible Listing for Pediatric Heart Transplantation Results in Comparable Post-Transplant Rejection-Free Survival in a Single-Center Series.

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Pediatric Cardiology Pub Date : 2025-10-01 Epub Date: 2024-08-08 DOI:10.1007/s00246-024-03601-x
Emily A Downs, Michal Schäfer, Melanie D Everitt, Michael Aubrey, Max Mitchell, James Jaggers, David Campbell, Matthew L Stone
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引用次数: 0

Abstract

ABO-incompatible (ABOi) heart transplantation (HT) has increased organ availability for infants with end-stage heart failure. Despite increasing adoption of ABOi listing for HT, data remain limited regarding pre- and post-HT immunologic profiles to guide listing practices and post-HT follow-up. Thus, the purpose of this study was to evaluate post-HT outcomes at a single center employing inclusive ABOi listing irrespective of pre-HT isohemagglutinin titers. All HT recipients listed at less than 24 months of age at our institution from 2010-2020 were included. Pre- and post-operative variables were compared for ABOi and ABO-compatible (ABOc) recipients. Separate iso-IgG and iso-IgM titers were monitored pre- and post-HT. Primary outcomes were compared between ABOi versus ABOc groups at mid-term follow-up. 51 HTs were performed on 50 patients from 2010-2020 (ABOi, N = 13; ABOc, N = 38). Six ABOi recipients received intra-operative plasma exchange for elevated titers (greater than 1:8 for IgG or IgM or reverse type greater than 2 +). Treated rejection, DSA, CAV, primary graft failure, need for re-HT, and survival were comparable between ABOi and ABOc groups at mid-term follow-up. An inclusive approach to ABOi HT listing for infants less than 24 months of age results in comparable post-transplant rejection-free survival, CAV, and prevalence of DSA at mid-term follow-up. These data define a potential role for specific IgM and IgG testing to promote understanding of risk stratification in pediatric ABOi listing, and support an inclusive strategy irrespective of high pre-HT titers to expand the number of available donor hearts for infants and older children awaiting HT.

Abstract Image

在一个单中心系列研究中,小儿心脏移植手术的包容性ABO不相容列表可获得相似的移植后无排斥生存率。
ABO血型不相容(ABOi)心脏移植(HT)增加了终末期心力衰竭婴儿的器官可用性。尽管越来越多的人采用 ABOi 法进行心脏移植,但有关心脏移植前后免疫学特征的数据仍然有限,无法指导心脏移植的筛选和移植后的随访。因此,本研究的目的是评估一个采用包容性 ABOi 排序的单一中心的 HT 术后结果,而不考虑 HT 术前的异血凝素滴度。本研究纳入了 2010-2020 年期间在本机构登记的所有年龄小于 24 个月的 HT 受者。比较了ABOi和ABO相容(ABOc)受者的术前和术后变量。HT术前和术后分别监测了iso-IgG和iso-IgM滴度。在中期随访时,对 ABOi 组和 ABOc 组的主要结果进行比较。2010-2020 年间,50 名患者接受了 51 次 HT(ABOi 组,13 人;ABOc 组,38 人)。6名ABOi受者因滴度升高(IgG或IgM大于1:8或反向型大于2 +)接受了术中血浆置换。在中期随访中,ABOi组和ABOc组的治疗排斥反应、DSA、CAV、原发性移植物失败、再次HT需求和存活率相当。对年龄小于24个月的婴儿进行ABOi HT列表的包容性方法可在中期随访时获得相似的移植后无排斥生存率、CAV和DSA发生率。这些数据确定了特异性 IgM 和 IgG 检测的潜在作用,以促进对儿科 ABOi 分类中风险分层的理解,并支持采取包容性策略(无论 HT 前滴度高低),为等待 HT 的婴儿和年龄较大的儿童增加可用供体心脏的数量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Cardiology
Pediatric Cardiology 医学-小儿科
CiteScore
3.30
自引率
6.20%
发文量
258
审稿时长
12 months
期刊介绍: The editor of Pediatric Cardiology welcomes original manuscripts concerning all aspects of heart disease in infants, children, and adolescents, including embryology and anatomy, physiology and pharmacology, biochemistry, pathology, genetics, radiology, clinical aspects, investigative cardiology, electrophysiology and echocardiography, and cardiac surgery. Articles which may include original articles, review articles, letters to the editor etc., must be written in English and must be submitted solely to Pediatric Cardiology.
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