Pediatric Heart Transplantation Across a Positive Cross-Match Is Associated with High Rates of AMR but No Difference in Short Term Graft Loss, Dysfunction and Death (CTOTC-04 study).

S. Webber,¹ L. Addonizio,² E. Blume,³ A. Dipchand,⁴ R. Shaddy,⁵ B. Feingold,⁶ C. Canter,⁷ D. Hsu,⁸ W. Mahle,⁹ A. Zeevi,⁶ K. Much,¹⁰ D. Ikle,¹⁰ H. Diop,¹¹ J. Odim, MD, PhD, for CTOTC-04 Investigators.¹¹

¹Vanderbilt, Nashville
²Columbia Univ., NYC
³Boston Children's, Boston
⁴Sick Kids, Toronto, Canada
⁵CHOP, Philadelphia
⁶CHP of UPMC, Pittsburgh
⁷Washington Univ., St. Louis
⁸Children's Hospital, Montefiore, NYC
⁹CHOA, Atlanta
¹⁰Rho, Chapel Hill
¹¹NIAID/NIH, Bethesda.

Meeting: 2016 American Transplant Congress

Abstract number: 572

Keywords: Alloantibodies, Heart, Pediatric, Rejection

Topic:

Session Information

Session Name: Concurrent Session: Late Breaking

Date: Monday, June 13, 2016

Session Time: 4:30pm-6:00pm

Presentation Time: 4:30pm-4:42pm

Location: Room 210

Sensitization is common in pediatric heart transplant (HT) candidates. Waitlist mortality is high if a prospective -ve CDC-crossmatch (XM) is required, but HT across a +ve XM is considered high risk for rejection & graft loss. CTOTC-04 is a multicenter prospective study assessing the impact of pre-HT sensitization on HT outcomes. Methods: We prospectively recruited consecutive candidates (<21 yr) at 8 pediatric centers. Pts were categorized as non-sensitized (cohort A) or sensitized (cohort B) defined as pre-HT +ve Luminex screen with ≥1 anti-HLA Ab at ≥1000 MFI confirmed by single antigen beads. Cohort B XM +ve pts were identified at HT. Immunosuppression was standardized (thymoglobulin with tacrolimus/MMF maintenance). XM +ve pts also received periop Ab removal, maintenance steroids, IVIG. Primary endpoint was 1 yr incidence rate of composite of death, reHT, and rejection with hemodynamic compromise. Results:317 were screened, 290 consented & 240transplanted. Cohort A (n=97;40%) had mean age 7.0±6.8 yr at HT, 45% male and 34% with congenital heart disease (CHD). Cohort B (n=143;60%) comprised 16 XM +ve recipients 8.0±6.8 yr, 69% male, 81% CHD, and 127 XM -ve, 7.6±6.4 yr, 58% male, 49% CHD. Incidence rates of the primary endpoint did not statistically differ; cohort A 5.2% (CI:1.7%, 11.6%), cohort B +ve XM 12.5% (1.6%, 38.4%), cohort B -ve XM 11.8% (6.8%, 18.7%), p=0.161. Individual components of the primary endpoint did not differ, but 1-year incidence rate of AMR was higher in the +ve XM group (37.5%) compared to cohort A (4.1%) and cohort B -ve XM (15.0%), p≤0.001. Conclusions: In the short-term, the composite endpoint did not differ based on sensitization or XM status despite varying rates of AMR. Subsequent analyses will assess outcomes based on MFI of DSA and long-term follow-up will assess late graft / pt outcomes.

CITATION INFORMATION: Webber S, Addonizio L, Blume E, Dipchand A, Shaddy R, Feingold B, Canter C, Hsu D, Mahle W, Zeevi A, Much K, Ikle D, Diop H, Odim, MD, PhD, for CTOTC-04 Investigators J. Pediatric Heart Transplantation Across a Positive Cross-Match Is Associated with High Rates of AMR but No Difference in Short Term Graft Loss, Dysfunction and Death (CTOTC-04 study). Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Webber S, Addonizio L, Blume E, Dipchand A, Shaddy R, Feingold B, Canter C, Hsu D, Mahle W, Zeevi A, Much K, Ikle D, Diop H, Odim J, Investigators forCTOTC-04. Pediatric Heart Transplantation Across a Positive Cross-Match Is Associated with High Rates of AMR but No Difference in Short Term Graft Loss, Dysfunction and Death (CTOTC-04 study). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/pediatric-heart-transplantation-across-a-positive-cross-match-is-associated-with-high-rates-of-amr-but-no-difference-in-short-term-graft-loss-dysfunction-and-death-ctotc-04-study/. Accessed June 24, 2021.

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