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. 2023 Nov;27(7):e14593.
doi: 10.1111/petr.14593. Epub 2023 Aug 21.

Contemporary outcomes of pediatric cardiac transplantation with a positive retrospective crossmatch

Irene D Lytrivi  1 , Devin Koehl  2 , Paul Esteso  3 , Erik L Frandsen  4 , Meredith K Gibbons  1 , James K Kirklin  2   5 , Ryan Cantor  2 , Jacqueline M Lamour  6 , Adam Putschoegl  7 , Svetlana Shugh  8 , Ryan J Williams  3 , F Bennett Pearce  9
Affiliations

Contemporary outcomes of pediatric cardiac transplantation with a positive retrospective crossmatch

Irene D Lytrivi et al. Pediatr Transplant. 2023 Nov.

Abstract

Background: A positive crossmatch (+ XM) has traditionally been associated with adverse outcomes following pediatric heart transplantation. However, more recent studies suggest that favorable intermediate-term outcomes may be achieved despite a + XM. This study's hypothesis is that children with a + XM have similar long-term survival, but higher rate of complications such as rejection, coronary allograft vasculopathy (CAV), and infection, compared to patients with a negative (-) XM.

Methods: The Pediatric Heart Transplant Society Registry (PHTS) database was queried from 2010-2021 for all patients <18 years of age with a known XM. Baseline demographics were compared between + XM and - XM groups using appropriate parametric and non-parametric group comparisons. Cox Proportional Hazards Modeling was used to identify risk factors for post-transplant graft loss, rejection, and CAV.

Results: Of 4599 pediatric heart transplants during the study period, XM results were available for 3914 (85%), of which 373 (9.5%) had a + XM. Univariate analysis showed lower 10-year survival for patients with + XM (HR = 1.3, p = .04). Multivariate analyses revealed no significant difference in 10-year survival in the 2 groups; however, time to first rejection (p = .0001) remained significantly shorter in the + XM group.

Conclusions: Pediatric patients transplanted across a + XM experience earlier rejection; however, after multivariate adjustment, + XM is not independently associated with intermediate-term graft loss. The risk of heart transplantation against a + XM must be balanced with the ongoing risk of waitlist mortality.

Keywords: children; heart transplantation complications; positive crossmatch.

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References

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