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. 2013 Jan;32(1):56-62.
doi: 10.1016/j.healun.2012.09.023. Epub 2012 Nov 13.

Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation

Brian Feingold  1 , Seo Young Park, Diane M Comer, Charity G Moore, Steven A Webber, Cindy L Bryce
Affiliations

Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation

Brian Feingold et al. J Heart Lung Transplant. 2013 Jan.

Abstract

Background: Allosensitization is associated with inferior waitlist outcomes in pediatric heart transplant candidates, presumably because of the requirement for a negative prospective crossmatch. However, there are no reports of heart transplant candidate outcomes according to prospective crossmatch requirements.

Methods: We analyzed data on all children listed for isolated heart transplantation from 1995 to 2009 in the USA according to prospective crossmatch requirement (PXMR). Primary objectives were to describe the prevalence of PXMR at and during listing and to compare waitlist and post-transplant survival for patients based on PXMR. Patients with a PXMR during listing include those with a PXMR at the time of listing as well as those who were designated by the listing center as needing a prospective crossmatch at some point after being placed onto the waitlist.

Results: Among 6,343 listed children, 7.7% had a requirement for a prospective crossmatch at the time of listing and 11.8% had a requirement for a prospective crossmatch during listing. After controlling for risk factors associated with inferior survival, PXMR at listing was associated with increased waitlist mortality (HR 1.32, 95% CI 1.10 to 1.56; p = 0.003). Recipients with a PXMR during listing more commonly had a positive DSXM (22.1% vs 10.3%, p < 0.0001), as did recipients who carried a PXMR throughout listing (21.7% vs 11.3%, p = 0.004). However, there was no significant difference in post-transplant survival on the basis of a PXMR during listing (HR 1.04, 95% CI 0.87 to 1.25; p = 0.67). Nearly 30% of recipients with a PXMR during listing had a peak pre-transplant PRA ≤ 10%.

Conclusions: PXMR increases the likelihood of death while awaiting, but not after, pediatric heart transplantation. Further study is necessary to understand how PXMR is applied, and changes, after listing for pediatric heart transplantation.

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Conflict of interest statement

Disclosure statement: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Waitlist competing outcomes stratified by the requirement for a prospective crossmatch at listing (a, b) and throughout the entirety of listing (c, d).
Figure 2
Figure 2
Freedom from death after transplantation, stratified by the requirement for a prospective crossmatch during listing.
See this image and copyright information in PMC

References

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    1. Dipchand AI, Naftel DC, Feingold B, et al. Outcomes of children with cardiomyopathy listed for transplant: a multi-institutional study. J Heart Lung Transplant. 2009;28:1312–21. - PubMed
    1. Jacobs JP, Quintessenza JA, Boucek RJ, et al. Pediatric cardiac transplantation in children with high panel reactive antibody. Ann Thorac Surg. 2004;78:1703–9. - PubMed

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