Showing papers by "Edgar L. Milford published in 2013"

Antibody depletion for the treatment of crossmatch-positive pediatric heart transplant recipients.

Abstract: Sensitization to human leukocyte antigens (HLA) is a risk factor for adverse outcomes after heart transplantation. Requiring a negative prospective crossmatch results in longer waiting times and increased waitlist mortality. We report outcomes in a cohort of sensitized children who underwent transplant despite a positive complement dependent cytotoxicity (CDC) crossmatch (CM+) using a protocol of antibody depletion at time of transplant, followed by serial intravenous immunoglobulin administration. All patients less than 21 years old who underwent heart transplantation at Boston Children’s Hospital from 1/1998-1/2011 were included. We compared freedom from allograft loss, allograft rejection, and serious infection between CM+ and CM− recipients. Of 134 patients in the cohort, 33 (25%) were sensitized prior to transplantation and 12 (9%) received a CM+ heart transplant. Serious infection in the first post-transplant year was more prevalent in the CM+ patients compared to CM− patients (50% vs. 16%;P=0.005), as was hemodynamically significant antibody mediated rejection (50% vs. 2%;P<0.001). There was no difference in freedom from allograft loss or any rejection. At our center, children transplanted despite a positive crossmatch had acceptable allograft survival and risk of any rejection, but a higher risk of hemodynamically significant antibody-mediated rejection and serious infection.