Purpose: Utilization of positive (+) cross-match (XM) hearts is tempting when shortages of pediatric donor hearts exist, especially for patients with high pre-transplant panel reactive antibodies (PRA), for whom a negative (-) XM organ may be difficult to find., We sought to define the HLA antibodies present and patient outcomes in recipients of a +XM donor heart at our single center heart transplant (HTx) program to better delineate the safety of this practice, guide donor selection, and ultimately, characterize the anti-HLA antibodies produced in this subset of patients who receive a +XM donor heart.

Methods: We retrospectively reviewed the electronic medical records of patients who received a HTx at our institution from January 2007 to August 2014. P values were calculated by Chi Square, Fisher's exact test, or t-test as appropriate.

Results: 117 patients received a HTx during the specified period, of which 10 (9%) had a +XM. 3 additional patients had false positive crossmatches due to Rituximab or Fc Receptor background interference. All +XM patients were flow positive and two (20 %) were also B and T cell CDC positive. In +XM patients 80% had generated anti-HLA antibodies to class II specificities and 20% to class I specificities. We found anti-HLA antibodies to DQ loci on were most frequent in 70% of +XM cases. The mean peak PRA in the year preceding transplant was 14% class I and 8% class II for the -XM group and 60% and 73% for the +XM group (p= <0.01). Mortality at 1-year post-HTx for the -XM group was 5.1% vs 30% for the +XM group, p<0.001. The mortality rate for the two CDC positive patients was 50%. Mortality at 3-years post-HTx for those with an adequate follow-up time was 10% for –XM patients and 45% for +XM patients, p=0.002. The rate of rejection requiring treatment was 21% at 90 days and 30% at 1 year for the –XM patients, compared to 58% at 90 days and 60% at 1 year for the +XM group, P=0.004 and 0.05 respectively.

Conclusions:The results of our single center experience indicate that heightened vigilance is needed for those patients who receive a +XM organ. Additional investigation is warranted to evaluate alternative treatment strategies for these high-risk patients.

CITATION INFORMATION: Jindra P, Nicholas S, Chappelle J, Humlicek T, Hosek K, Heinle J, Denfield S, Jeewa A, Kerman R, Dreyer W. Anti-HLA Antibody Composition and Outcomes in Pediatric Heart Transplant Recipients with a Positive Cross-Match. Am J Transplant. 2016;16 (suppl 3).

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