Heart transplant

Association between homograft tissue exposure and allosensitization prior to heart transplantation in patients with congenital heart disease

This article was originally published here

Pediatric transplantation. December 10, 2021: e14201. doi: 10.1111 / petr.14201. Online ahead of print.


BACKGROUND: Surgical repair for patients with congenital heart disease (CHD) often incorporates homograft tissue or other foreign material that can lead to allosensitization. We sought to identify the relationship between pre-sensitization before heart transplantation and exposure to homograft tissue in coronary patients.

METHODS: Retrospective review of the records of all coronary patients who underwent heart transplantation in a large pediatric transplant center between 01/01/2011 and 03/31/18. Operative records determined the use of homograft tissue or foreign material. Reactive Antibody Panel (PRA) and LuminexMT Single Antigen Bead (SAB) test results were reviewed. Statistical analysis determined the probabilities of pre-sensitization in patients exposed to homograft tissue.

RESULTS: Fifty-six coronary patients underwent transplantation during the review period. Thirteen patients (23%) were presensitized by PRA> 10%. By SAB test, 33 patients (59%) developed an anti-HLA antibody> 0 MFI, 30 patients (54%)> 2000 MFI and 19 patients (34%)> 6000 MFI. Patients with homografts were more likely to be presensitized by PRA (OR = 7.31, p = 0.007) and to have developed anti-HLA antibody at various levels,> 0 (OR = 4, 52, p = 0.034),> 2000 (OR = 8.59, p = 0.003) and> 6000 (OR = 8.50, p = 0.004). Among the patients with homografts, those pre-sensitized by PRA had longer exposure times (9.80 vs 4.96 years, p = 0.025). There was no difference in the exposure time compared to pre-sensitization by the BSA test.

CONCLUSIONS: Previous exposure to homograft tissue appears to increase the chances of pre-sensitization by the PRA or SAB test. A longer exposure time to homograft tissue prior to transplantation is associated with increased pre-sensitization during transplantation, as determined by the ARP, but not by the BSA test.

PMID:34889487 | DO I:10.1111 / petr.14201