Donor–Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation

Kanter, Kirk R.; Berg, Alexandria M.; Mahle, William T.; Vincent, Robert; Kilgo, Patrick D.; Kogon, Brian; Kirshbom, Paul M.

doi:10.1016/j.athoracsur.2008.09.074

Cited by 30 publications

(27 citation statements)

References 22 publications

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“…Prior data have shown a slightly higher incidence of positive retrospective crossmatch in black HT recipients compared with whites. 27 However, this variable was not associated with overall graft survival in adjusted models. In addition, a recent analysis of OPTN data has shown the proportion of white, black, and Hispanic HT recipients receiving mycophenolate was similar in recent eras, with a higher proportion of black recipients (vs whites) receiving tacrolimus.…”

Section: Discussionmentioning

confidence: 96%

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Morris

Καλογερόπουλος

Zhao

et al. 2015

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 96%

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Morris

Καλογερόπουλος

Zhao

et al. 2015

The Journal of Heart and Lung Transplantation

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“…26 Donor-recipient race matching has been associated with increased graft survival in all races in pediatric heart transplantation. 27 The graft survival associated with donor:recipient race matching is likely due to increasing degree of HLA matching when donor and recipient race are the same.…”

Section: Discussionmentioning

confidence: 99%

Association of Human Leukocyte Antigen Donor–Recipient Matching and Pediatric Heart Transplant Graft Survival

Butts

Scheurer

Atz

et al. 2014

Circ: Heart Failure

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Background The effect of donor-recipient human leukocyte antigen (HLA) matching on outcomes remains relatively unexplored in pediatric patients. The objective of this study was to investigate the effects of donor-recipient HLA matching on graft survival in pediatric heart transplantation. Methods and Results The UNOS database was queried for heart transplants occurring between October 31, 1987 to December 31, 2012 in a recipient aged ≤ 17 with at least one postoperative follow-up visit. Retransplants were excluded. Transplants were divided into 3 donor-recipient matching groups: no HLA matches (HLA-no), 1 or 2 HLA matches (HLA-low), and 3-6 HLA matches (HLA-high). Primary outcome was graft loss. 4471 heart transplants met study inclusion criteria. High degree of donor-recipient HLA matching occurred infrequently; (HLA-high n=269 (6 %) v. HLA-low n=2683 (60%) v. HLA-no n=1495 (34%). There were no differences between HLA matching groups in frequency of coronary vasculopathy (p=0.19) or rejection in the first post-transplant year (p=0.76). Improved graft survival was associated with a greater degree of HLA donor-recipient matching: HLA-high median survival 17.1yrs (14.0-20.2yrs, 95%CI), HLA-low median survival 14.2yrs (13.1-15.4), and HLA-no median survival 12.1yrs (10.9-13.3), p<0.01 log rank test. In Cox-regression analysis, HLA matching was independently associated with decreased graft loss [HLA-low v. HLA-no HR 0.86 (0.74-0.99, 95%CI), p=0.04; HLA-high v. HLA-no 0.62 (0.43-0.90, 95%CI), p<0.01]. Conclusions Decreased graft loss in pediatric heart transplantation was associated with a higher degree of donor-recipient HLA matching, although a difference in the frequency of early rejection or development of coronary artery vasculopathy was not seen.

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“…(21, 25, 26) Investigators have speculated that an increase in the number of HLA mismatches in black recipients and a predisposition to a pro-inflammatory host environment may contribute to decreased graft survival in black heart transplant recipients. (22–24, 27)…”

Section: Discussionmentioning

confidence: 99%

Sudden death after pediatric heart transplantation: Analysis of data from the Pediatric Heart Transplant Study Group

Daly¹,

Chakravarti²,

Tresler³

et al. 2011

The Journal of Heart and Lung Transplantation

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BACKGROUND Sudden death is a well-recognized complication of heart transplantation. Little is known about the incidence and risk factors for sudden death following transplant in children. The purpose of this study was to determine the incidence of and risk factors for sudden death. METHODS Retrospective multi-center cohort study using the Pediatric Heart Transplant Study Group (PHTS) database, an event driven registry of children <18 years of age at listing undergoing heart transplantation between 1993 and 2007. Standard Kaplan-Meier and parametric analyses were used for survival analysis. Multivariate analysis in the hazard-function domain was used to identify risk factors for sudden death after transplant. RESULTS Of 2491 children who underwent heart transplantation, 604 died of which 94 (16%) were classified as sudden. Freedom from sudden death was 97% at 5 years and the hazard for sudden death remained constant over time at 0.01 deaths per year. Multivariate risk factors associated with sudden death include black race (HR 2.6; p<0.0001), UNOS Status 2 at transplant (HR 1.8; p=0.008), older age (HR 1.4 per 10 years of age; p=0.03), and an increased number of rejection episodes in the first post-transplant year (HR 1.6 per episode; p=0.03). CONCLUSION Sudden death accounts for one in six deaths after heart transplant in children. Older recipient age, recurrent rejection within the first year, black race, and UNOS status 2 at listing were associated with sudden death. Patients with one or more of these risk factors may benefit from primary prevention efforts.

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Donor–Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation

Cited by 30 publications

References 22 publications

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation

Association of Human Leukocyte Antigen Donor–Recipient Matching and Pediatric Heart Transplant Graft Survival

Sudden death after pediatric heart transplantation: Analysis of data from the Pediatric Heart Transplant Study Group

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