PDF(Pubmed)
Abstract：
BACKGROUND: Pediatric heart transplant (HT) candidates experience high waitlist mortality due to a limited donor pool that is constrained in part by anti-HLA sensitization. We evaluated the impact of CDC and Flow donor-specific crossmatch (XM) results on pediatric HT outcomes.
METHODS: All pediatric HTs between 1999 and 2019 in the OPTN database were included. Donor-specific XM results were sub-categorized based on CDC and Flow results. Primary outcomes were treated rejection in the first year and time to death or allograft loss. Propensity scores were utilized to adjust for differences in baseline characteristics.
RESULTS: A total of 4,695 pediatric HT patients with T-cell XM data were included. After propensity score adjustment, a positive T-cell CDC-XM was associated with 2 times higher odds of treated rejection (OR 2.29 (1.56, 3.37)) and shorter time to death/allograft loss (HR 1.50 (1.19, 1.88)) compared to a negative Flow-XM. HT recipients who were Flow-XM positive with negative/unknown CDC-XM did not have higher odds of rejection or shorter time to death/allograft loss. An isolated positive B-cell XM was also not associated with worse outcomes. Over the study period XM testing shifted from CDC- to Flow-based assays.
CONCLUSIONS: A positive donor-specific T-cell CDC-XM was associated with rejection and death/allograft loss following pediatric HT. This association was not observed with a positive T-cell Flow-XM or B-cell XM result alone. The shift away from performing the CDC-XM may result in loss of important prognostic information unless the clinical relevance of quantitative Flow-XM results on heart transplant outcomes is systematically studied.
METHODS: All pediatric HTs between 1999 and 2019 in the OPTN database were included. Donor-specific XM results were sub-categorized based on CDC and Flow results. Primary outcomes were treated rejection in the first year and time to death or allograft loss. Propensity scores were utilized to adjust for differences in baseline characteristics.
RESULTS: A total of 4,695 pediatric HT patients with T-cell XM data were included. After propensity score adjustment, a positive T-cell CDC-XM was associated with 2 times higher odds of treated rejection (OR 2.29 (1.56, 3.37)) and shorter time to death/allograft loss (HR 1.50 (1.19, 1.88)) compared to a negative Flow-XM. HT recipients who were Flow-XM positive with negative/unknown CDC-XM did not have higher odds of rejection or shorter time to death/allograft loss. An isolated positive B-cell XM was also not associated with worse outcomes. Over the study period XM testing shifted from CDC- to Flow-based assays.
CONCLUSIONS: A positive donor-specific T-cell CDC-XM was associated with rejection and death/allograft loss following pediatric HT. This association was not observed with a positive T-cell Flow-XM or B-cell XM result alone. The shift away from performing the CDC-XM may result in loss of important prognostic information unless the clinical relevance of quantitative Flow-XM results on heart transplant outcomes is systematically studied.
摘要：
背景：儿童心脏移植（HT）候选人由于有限的供体库部分受抗HLA致敏作用的限制，因此候补死亡率高。我们评估了CDC和Flow供体特异性交叉匹配（XM）结果对儿科HT结果的影响。
方法：纳入OPTN数据库中1999年至2019年的所有儿科HT。基于CDC和Flow结果对供体特异性XM结果进行子分类。主要结果是第一年的治疗排斥和死亡或同种异体移植物丢失的时间。使用倾向评分来调整基线特征的差异。
结果：纳入了4695名具有T细胞XM数据的儿童HT患者。在倾向得分调整后，与阴性Flow-XM相比,阳性T细胞CDC-XM与治疗排斥反应的几率高2倍(OR2.29(1.56,3.37))和更短的死亡/同种异体移植丢失时间(HR1.50(1.19,1.88))相关.Flow-XM阳性且CDC-XM阴性/未知的HT接受者没有较高的排斥几率或较短的死亡/同种异体移植物丢失时间。分离的阳性B细胞XM也与较差的结果无关。在研究期间,XM测试从基于⑶C的测定转变为基于流的测定。
结论：供体特异性T细胞CDC-XM阳性与小儿HT后的排斥反应和死亡/同种异体移植物丢失有关。单独使用阳性T细胞Flow-XM或B细胞XM结果未观察到这种关联。除非系统地研究定量Flow-XM结果与心脏移植结果的临床相关性，否则从执行CDC-XM的转变可能会导致重要的预后信息丢失。
方法：纳入OPTN数据库中1999年至2019年的所有儿科HT。基于CDC和Flow结果对供体特异性XM结果进行子分类。主要结果是第一年的治疗排斥和死亡或同种异体移植物丢失的时间。使用倾向评分来调整基线特征的差异。
结果：纳入了4695名具有T细胞XM数据的儿童HT患者。在倾向得分调整后，与阴性Flow-XM相比,阳性T细胞CDC-XM与治疗排斥反应的几率高2倍(OR2.29(1.56,3.37))和更短的死亡/同种异体移植丢失时间(HR1.50(1.19,1.88))相关.Flow-XM阳性且CDC-XM阴性/未知的HT接受者没有较高的排斥几率或较短的死亡/同种异体移植物丢失时间。分离的阳性B细胞XM也与较差的结果无关。在研究期间,XM测试从基于⑶C的测定转变为基于流的测定。
结论：供体特异性T细胞CDC-XM阳性与小儿HT后的排斥反应和死亡/同种异体移植物丢失有关。单独使用阳性T细胞Flow-XM或B细胞XM结果未观察到这种关联。除非系统地研究定量Flow-XM结果与心脏移植结果的临床相关性，否则从执行CDC-XM的转变可能会导致重要的预后信息丢失。
