The impact of flow PRA on outcome in pediatric heart recipients in modern era: An analysis of the Pediatric Heart Transplant Study database
Corresponding Author
B. B. Das
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
Correspondence
Bibhuti Das, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Search for more papers by this authorE. Pruitt
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
Search for more papers by this authorK. Molina
Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
Search for more papers by this authorW. Ravekes
Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorS. Auerbach
Department of Pediatrics, Children's Hospital of Colorado, Aurora, CO, USA
Search for more papers by this authorA. Savage
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Search for more papers by this authorJ. K. Kirklin
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
Search for more papers by this authorD. C. Naftel
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
Search for more papers by this authorD. Hsu
Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, NY, USA
Search for more papers by this authorthe Pediatric Heart Transplant Study Investigators
Search for more papers by this authorCorresponding Author
B. B. Das
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
Correspondence
Bibhuti Das, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Search for more papers by this authorE. Pruitt
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
Search for more papers by this authorK. Molina
Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
Search for more papers by this authorW. Ravekes
Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorS. Auerbach
Department of Pediatrics, Children's Hospital of Colorado, Aurora, CO, USA
Search for more papers by this authorA. Savage
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Search for more papers by this authorJ. K. Kirklin
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
Search for more papers by this authorD. C. Naftel
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
Search for more papers by this authorD. Hsu
Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, NY, USA
Search for more papers by this authorthe Pediatric Heart Transplant Study Investigators
Search for more papers by this authorAbstract
Data from patients in the Pediatric Heart Transplant Study (PHTS) registry transplanted between 2010 and 2014 were analyzed to determine the association between HLA antibody (PRA) determined by SPA using Luminex or flow cytometry with a positive retrospective cross-match and the post-transplant outcomes of acute rejection and graft survival. A total of 1459 of 1596 (91%) recipients had a PRA reported pretransplant; 26% had a PRA > 20%. Patients with a PRA > 20% were more likely to have CHD, prior cardiac surgery, ECMO support at listing, and waited longer for transplantation than patients with a PRA <20%. Patients with higher PRA% determined by SPA were predictive of a positive retrospective cross-match determined by flow cytometric method (P < .001). A PRA > 50% determined by SPA was independently associated with worse overall graft survival after first month of transplant in both unadjusted and adjusted for all other risk factors. In this large multicenter series of pediatric heart transplant recipients, an elevated PRA determined by SPA remains a significant risk factor in the modern era.
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