Human Leukocyte Antigen Sensitization in Pediatric Patients Exposed to Mechanical Circulatory Support

Hong, Borah J.*; Delaney, Meghan†‡; Guynes, Anthony; Warner, Paul; McMullan, David M.§; Kemna, Mariska S.; Boucek, Robert J.; Law, Yuk M.

ASAIO Journal:
doi: 10.1097/MAT.0000000000000053
Pediatric Circulatory Support
Abstract

Human leukocyte antigen (HLA) sensitization of pediatric heart recipients increases their risk of rejection and graft loss. As more children are placed on mechanical circulatory support (MCS) as a bridge to transplant, the risk factors for development of sensitization warrant further study. A single-center retrospective review of 36 children who received MCS identified 22 patients supported with either extracorporeal membrane oxygenation (ECMO) (n = 15) or ECMO-ventricular assist device (VAD) (n = 7) with paired (pre-MCS/post-MCS) panel reactive antibodies (PRA) or only negative post-MCS PRAs. Four patients (18%) became sensitized post-MCS (one ECMO-only patient, three ECMO-VAD patients). No difference was found between sensitized and nonsensitized patients in terms of congenital heart disease versus primary cardiomyopathy (p = 0.096), duration of MCS (38 days vs. 14 days, p = 0.233), or volume of blood product transfusions (358.6 ml/kg vs. 612.7 ml/kg, p = not significant). By multivariable analysis, the association of sensitization with older age at MCS (p = 0.076) and history of homograft (p = 0.064) approached significance. Pediatric patients supported with MCS are at low risk of developing HLA sensitization. Diagnosis, MCS duration, and volume of transfused blood products do not appear to be associated with HLA sensitization, but there is a suggestion of an association with older age at MCS and history of a homograft.

Author Information

From the *Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas; Puget Sound Blood Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington; §Division of Pediatric Cardiothoracic Surgery, Seattle Children’s Hospital, University of Washington, Seattle, Washington; and Division of Pediatric Cardiology, Seattle Children’s Hospital, University of Washington, Seattle, Washington.

Submitted for consideration September 2013; accepted for publication in revised form January 2014.

Disclosure: The authors have no conflicts of interest to report.

Reprint Requests: Borah J. Hong, Division of Pediatric Cardiology, Texas Children’s Hospital, 6621 Fannin Street, MC-19345-C, Houston, TX 77030-2399. Email: bjhong@texaschildrens.org

Copyright © 2014 by the American Society for Artificial Internal Organs