Abstract 15882: Effect of HLA Matching on Pediatric Heart Transplant Graft Survival
Background: HLA typing of donors and recipients is routine in heart transplant. The effect of donor-recipient 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 in pediatric heart transplantation.
Methods: The UNOS database was queried for isolated heart transplants that occurred from 1988 to 2012 with a recipient age of 17 or less. All cases with donor and recipient HLA A, B, and DR antigens reported were included. Transplants were divided into 3 groups: no HLA matches (HLA-no), 1 or 2 HLA matches (HLA-low), and 3-6 HLA matches (HLA-high). Primary outcome was graft survival. Cox-regression analysis was performed to determine the effect of HLA matching on graft survival. Pateint related factors included in the analysis were: recipient age, ischemic time, recipient on ventilator, ECMO, inotropes at time of transplant, serum bilirubin and creatinine, donor-recipient weight ratio, cardiac diagnosis, crossmatch results and transplant year.
Results: 4731 heart transplants in 4526 patients met study inclusion criteria. High degree of HLA matching occurred infrequently (HLA-high n=287 (6 %) v. HLA-low n=2852 (60%) v. HLA-no n=1592 (34%). Patient characteristics were similar amongst HLA match groups, except that HLA-high was more likely to be on ECMO at time of transplant (7.2%) v. HLA-no (3.1%) v. HLA-low (3.7%), p<0.01. Median graft survival for the entire cohort was 13.2 years (12.3-14.1, 95% CI). Graft survival improved with increasing level of HLA matching, HLA-high median survival 17.1yrs (14.1-20.1,95%CI), HLA-low median survival 13.7yrs (12.5-14.9), and HLA-no median survival 11.8yrs (10.8-13.9), p<0.01 log rank test. In cox-regression analysis, HLA matching was independently associated with graft survival [HLA-low v. HLA-no HR 0.83 (0.725-0.95, 95%CI), p<0.01; HLA-high v. HLA-no 0.60 (0.44-0.83, 95%CI), p<0.01].
Conclusion: Higher degree of HLA matching is associated with longer graft survival in pediatric heart transplants. This data will assist the heart transplant teams in evaluation of donor offers as well as identifying recipients at higher risk for worse outcomes.
- © 2013 by American Heart Association, Inc.