Ja. Hawkins et al., Class I and class II anti-HLA antibodies after implantation of cryopreserved allograft material in pediatric patients, J THOR SURG, 119(2), 2000, pp. 324-328
Citations number
28
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives: Very little is known regarding the immune response to cryo-pres
erved allograft valves and patch material used in the surgical repair of co
ngenital heart defects.
Methods: We prospectively measured the frequency of panel reactive antibodi
es directed against HLA class I (HLA-A, B, and C) and class II (HLA-DR/DQ)
alloantigens in 24 children receiving cryopreserved allografts. We compared
them with results in II previously reported control patients. Sixteen of t
he study patients underwent placement of a valved conduit (II. pulmonic, 5
aortic) between the right ventricle and pulmonary arteries, 6 underwent pat
ch angioplasty of stenotic vessels with cryopreserved pulmonary artery and
2 underwent placement of a pulmonary monocusp patch. Study patients had pan
el reactive antibodies measured before, 1 month, 3 months, and 1 year after
the operation.
Results: With allograft implantation, panel reactive antibodies increased f
rom 1.9% +/- 5% before the operation to 62% +/- 33% at 31 +/- 8 days after
the operation, 92% +/- 15% at 3.3 +/- 0.6 months after the operation, and 8
5% +/- 18% at 1.1 +/- 0.2 years after the operation. The control group show
ed no change in panel reactive antibodies, with a level of 1.6% +/- 1% befo
re the operation, 3.2% +/- 1% 28 +/- 5 days after the operation, and 1.7% /- 1% 2.7 +/- 0.3 months after the operation. Class II antibodies (anti-HLA
-DR/DQ) rose to 49% +/- 35% at 30 +/- 8 days and 70% +/- 26% at 3.3 +/- 0.6
months after the operation,
Conclusions: Cryopreserved allograft material induces a marked response tha
t involves both class I and class II anti-HLA antibodies within 3 months af
ter operation in children. This alloantibody response may represent a form
of "rejection," may have implications for those who require subsequent card
iac transplantation, and may play a role in early allograft failure.