Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Surgical repair for patients with congenital heart disease (CHD) often incorporates homograft tissue or other biologic material, which can lead to pre-sensitization. We sought to identify the relationship between pre-sensitization prior to heart transplant and exposure to homograft tissue in CHD patients.
*Methods: Retrospective chart review of all CHD patients who have undergone heart transplant at a major transplant center between 1/1/11 and 3/31/18. Operative records determined the use of homograft tissue or other biologic material. Complement-dependent cytotoxic panel reactive antibody (CDC-PRA) and pre-transplant LuminexTM mean fluorescence intensity (MFI) results were reviewed. Chi-squared and Fisher’s exact tests determined the odds of pre-sensitization in patients exposed to homograft tissue.
*Results: There were 56 CHD patients who underwent transplant during the review period and for whom operative records were available. Thirteen patients (23%) were pre-sensitized as determined by PRA>10%. By LuminexTM testing, 33 patients (59%) developed any anti-HLA antibody (MFI>0), 30 patients (54%) MFI> 2000, and 19 patients (34%) MFI> 6000. Patients who previously had received homografts were more likely to be pre-sensitized by PRA (p=0.007), and to have positive LuminexTM at various levels, MFI>0 (p=0.034), MFI>2000 (p=0.003), and MFI>6000 (p=0.004). Of patients who had received homografts, those that were pre-sensitized as determined by PRA had longer exposure times prior to transplant (9.80 ± 6.08 vs 4.96 ± 4.84 years, p=0.025). However, there was no difference in exposure time with relation to pre-sensitization as determined by LuminexTM test at any MFI cutoff.
*Conclusions: Previous exposure to homograft tissue appears to increase the odds of pre-sensitization by both the CDC-PRA and LuminexTM method of testing. Longer exposure time to homograft tissue prior to transplant is associated with increased pre-sensitization at time of transplant as determined by CDC-PRA, though not by specific anti-HLA testing via LuminexTM, suggesting the possibility of pre-sensitization with non-HLA antibodies.
To cite this abstract in AMA style:Donovan DJ, Richmond ME, Bacha EA, Addonizio LJ, Zuckerman WA. Association between Homograft Tissue Exposure and Pre-Sensitization Prior to Heart Transplant in Patients with Congenital Heart Disease [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/association-between-homograft-tissue-exposure-and-pre-sensitization-prior-to-heart-transplant-in-patients-with-congenital-heart-disease/. Accessed March 8, 2021.
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