Document Detail


Glutaraldehyde treatment of allograft tissue decreases allosensitization after the Norwood procedure.
MedLine Citation:
PMID:  20236668     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Cryopreserved allograft tissue used in the Norwood procedure for infants with hypoplastic left heart syndrome causes a marked immunologic sensitization that may complicate future heart transplantation. Treatment of the allograft tissue before implantation may prevent this sensitization. The purpose of this study was to assess the anti-human leukocyte antigen antibody response to glutaraldehyde-treated allograft tissue used in the repair of hypoplastic left heart syndrome. METHODS: Since June 2005, the University of Alberta has subjected allograft vascular tissue used in the Norwood procedure to glutaraldehyde treatment. An observational study was designed to assess whether glutaraldehyde treatment of the allograft tissue affected subsequent panel reactive antibody after patch implantation. Panel reactive antibodies for class I (human leukocyte antigen-A, B, C) and class II (human leukocyte antigen-DR, DQ) antibodies were measured 4 months postoperatively using flow cytometry. RESULTS: Fourteen patients underwent a Norwood procedure using glutaraldehyde-treated allograft tissue. Historical controls consisted of 12 patients who underwent a Norwood procedure using untreated allograft tissue. At 4 months, infants who had received glutaraldehyde-treated allograft tissue had lower class I panel reactive antibody (7.3% +/- 17.4% [median, 0%] vs 61.9% [median, 73%] +/- 39.9%; P = .0005) and class II panel reactive antibody (6.1% [median, 0%] +/- 22.7% vs 49.3% [median, 63%] +/- 41.9%, P = .001) compared with the historical controls. CONCLUSION: Intraoperative glutaraldehyde treatment of allograft tissue used in hypoplastic left heart syndrome repair prevents the profound immunologic sensitization that occurs in the majority of infants undergoing surgical palliation. In patients requiring subsequent heart transplantation, this decreases the risk of antibody-mediated rejection and increases the likelihood of finding a suitable donor, thus improving access to transplantation.
Authors:
Bryce J Laing; David B Ross; Steven R Meyer; Patricia Campbell; Anne M Halpin; Lori J West; Ivan M Rebeyka
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-03-16
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  139     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-06-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1402-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Cryopreservation
Female
Glutaral* / administration & dosage
Humans
Hypersensitivity / etiology,  prevention & control*
Hypoplastic Left Heart Syndrome / surgery*
Infant, Newborn
Male
Preoperative Care
Pulmonary Artery / transplantation*
Tissue Transplantation / adverse effects
Grant Support
ID/Acronym/Agency:
HL79067/HL/NHLBI NIH HHS; //Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
111-30-8/Glutaral

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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