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An Analysis of 183 Heart Transplants for Pediatric or Congenital Heart Disease—Impact of High Panel Reactive Antibody

The Annals of thoracic surgery, 2023-03, Vol.115 (3), p.733-741 [Peer Reviewed Journal]

2023 The Society of Thoracic Surgeons ;Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. ;ISSN: 0003-4975 ;EISSN: 1552-6259 ;DOI: 10.1016/j.athoracsur.2022.10.038 ;PMID: 36370883

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  • Title:
    An Analysis of 183 Heart Transplants for Pediatric or Congenital Heart Disease—Impact of High Panel Reactive Antibody
  • Author: Bleiweis, Mark S. ; Fricker, Frederick Jay ; Peek, Giles J. ; Gupta, Dipankar ; Shih, Renata ; Pietra, Biagio “Bill” ; Bobba, Chris ; Brennan, Zachary ; Mackie, Phil ; Stukov, Yuriy ; Purlee, Matthew ; Brown, Colton ; Kugler, Liam ; Sharaf, Omar M. ; Neal, Dan ; Goldstein, Steven S. ; Jacobs, Jeffrey Phillip
  • Subjects: Child ; Graft Rejection ; Heart Defects, Congenital - etiology ; Heart Transplantation - methods ; Humans ; Retrospective Studies ; Risk Factors ; Treatment Outcome
  • Is Part Of: The Annals of thoracic surgery, 2023-03, Vol.115 (3), p.733-741
  • Description: We reviewed our management strategy and outcome data for all 179 patients with pediatric and/or congenital heart disease who underwent 183 heart transplants from January 1, 2011, to December 31, 2021, and evaluated the impact of elevated panel reactive antibody (PRA). High PRA was defined as PRA >10%. Univariate associations with long-term survival were assessed with Cox proportional hazards models. Impact of high PRA on survival was estimated with multivariable models. PRA >10% was present in 60 of 183 transplants (32.8%), who were more likely to have prior cardiac surgery, higher number of prior cardiac operations, prior sternotomy, prior heart transplant, and positive crossmatch (24 of 60 [40.0%] vs 11 of 123 [8.9%], P < .0001). Univariate associations with long-term survival include acquired heart disease vs congenital or retransplant (hazard ratio [HR], 0.18; 95% CI, 0.053-0.593; P = .005), prior cardiac surgery (HR, 5.6; 95% CI, 1.32-23.75; P = .020), number of prior cardiac operations (HR, 1.3 for each additional surgery; 95% CI, 1.12-1.50; P = .0004), single ventricle (HR, 2.4; 95% CI, 1.05-5.48; P = .038), and preoperative renal dysfunction (HR, 3.4; 95% CI, 1.43-7.49; P = .002). In multivariate analysis, high PRA does not impact survival when controlling for each of the factors shown in univariable analysis to be associated with long-term survival. The Kaplan-Meier method provided the following survival estimates at 1 year (95% CI) and 5 years (95% CI) after cardiac transplantation: All patients, 93.6% (89.9%-97.3%) and 85.8% (80.0%-92.1%); PRA <10%, 96.6% (93.4%-99.9%) and 86.7% (79.6%-94.3%); and PRA >10%, 86.7% (78.0%-96.4%) and 83.8% (74.0%-95.0%). Despite high PRA being associated with higher mortality at 1 year (14.9% vs 3.8%, P = .035), no significant difference exists in Kaplan-Meier overall survival at 5 years posttransplant in patients with and without high PRA (log-rank P = .4). In our cohort, 5-year survival in patients with high PRA (PRA >10%) is similar to that in patients without high PRA (PRA <10%), despite the presence of more risk factors in those with high PRA. Individualized immunomodulatory strategies can potentially mitigate the risk of high PRA. [Display omitted]
  • Publisher: Netherlands: Elsevier Inc
  • Language: English
  • Identifier: ISSN: 0003-4975
    EISSN: 1552-6259
    DOI: 10.1016/j.athoracsur.2022.10.038
    PMID: 36370883
  • Source: MEDLINE
    Alma/SFX Local Collection
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