| Impact of antibodies against human leukocyte antigens on long-term outcome in pediatric heart transplant patients: an analysis of the United Network for Organ Sharing database. | |
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MedLine Citation:
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PMID: 20537356 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Controversy exists regarding the importance of circulating antibodies as determined by panel-reactive antibody screening as a risk factor for graft failure in pediatric patients undergoing heart transplantation. This study sought to determine the association of elevated anti-human leukocyte antibodies with long-term survival in pediatric heart transplant patients. METHODS: The United Network for Organ Sharing registry was queried for pediatric patients (aged < 18 years at listing) with panel-reactive antibody levels obtained before heart transplantation from 1987 through 2004. Survival analysis methods were used to assess the association of elevated panel-reactive antibodies with long-term graft and patient survival. RESULTS: Panel-reactive antibodies were obtained before transplantation from 3534 patients, median age 4 years (interquartile range 0-12 years). Most, 2711 (77%), had no detectable panel-reactive antibodies, 436 (12%) had panel-reactive antibodies of 1% to 10%, and 387 (11%) had panel-reactive antibodies greater than 10%. Patients with panel-reactive antibodies greater than 10% were more likely to be older (P = .04), have congenital heart disease (P < .001), and have a longer wait list time (P = .006). Patients with panel-reactive antibodies greater than 10% had significantly worse graft survival and patient survival than did patients with undetectable panel-reactive antibodies and panel-reactive antibodies of 1% to 10% (P < .05 for all). Controlling for confounding variables, elevated panel-reactive antibodies as a continuous variable and panel-reactive antibodies greater than 10% as a categorical variable were independently associated with decreased graft survival (P = .04 and P = .02, respectively). CONCLUSIONS: Elevated panel-reactive antibodies are independently associated with worse long-term graft survival in pediatric patients undergoing heart transplantation. Further study is needed to determine the optimal management of this high-risk population. |
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Authors:
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Joseph W Rossano; David L S Morales; Farhan Zafar; Susan W Denfield; Jeffrey J Kim; John L Jefferies; William J Dreyer |
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Publication Detail:
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Type: Journal Article Date: 2010-05-27 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-20 Completed Date: 2010-09-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 694-9, 699.e1-2 Citation Subset: AIM; IM |
Copyright Information:
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2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex 77030, USA. jrossano@bcm.tmc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Antibodies
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blood* Child Child, Preschool Female Graft Rejection / immunology*, mortality Graft Survival* HLA Antigens / immunology* Heart Transplantation / immunology*, mortality Histocompatibility Testing* Humans Infant Infant, Newborn Kaplan-Meiers Estimate Male Proportional Hazards Models Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Tissue and Organ Procurement* / statistics & numerical data Treatment Outcome United States / epidemiology Up-Regulation |
| Chemical | |
Reg. No./Substance:
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0/Antibodies; 0/HLA Antigens |
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