Abstract
Background Current knowledge of antibody-mediated rejection (AMR) after heart transplantation (HT) stems largely from adult data. Using the Pediatric Heart Transplant Study (PHTS) database, we report the incidence of AMR, describe treatment, and evaluate outcomes for treated AMR in children after HT. Methods We queried the PHTS database for patients <18 years of age undergoing primary HT between January 2010 and December 2014. An AMR episode was defined as either a biopsy consistent with pathologic AMR or a rejection event based on immunotherapy augmentation directed against antibody production. Biopsy data, treatment strategies and survival were analyzed. Results An episode of AMR was identified in 179 of 1,596 (11%) HT recipients and in 246 of 705 (35%) rejection episodes. AMR was diagnosed by biopsy in 182 of 246 episodes and by immunotherapy in 64 of 179 episodes. Mixed rejection was identified in 179. Freedom from AMR was 88% and 82% at 1 and 3 years, respectively. AMR therapies included intravenous immunoglobulin (IVIg) (58%), plasmapheresis (40%), rituximab (40%), bortezomib (11%) and eculizumab (0.4%). The most commonly used combination therapies included IVIg/plasmapheresis/rituximab (13%). Thirty-three patients (16%) died after developing AMR. Patient and graft survival were lower for the AMR+ group. One- and 3-year survival after initial AMR diagnosis was 88% and 77%, respectively. Conclusions In his study we report the largest experience of AMR in pediatric HT recipients. AMR was common and often occurred concurrently with acute cellular rejection. There is wide variability in the treatment of AMR. Short-term patient and graft outcomes were worse for those with treated AMR.
| Language | English (US) |
|---|---|
| Pages | 1497-1504 |
| Number of pages | 8 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 35 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2016 |
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Keywords
- acute cellular rejection
- antibody-mediated rejection
- heart transplantation
- humoral rejection
- immunotherapy
- pediatrics
- rejection
ASJC Scopus subject areas
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine
- Transplantation
Cite this
A multi-institutional evaluation of antibody-mediated rejection utilizing the Pediatric Heart Transplant Study database : Incidence, therapies and outcomes. / Thrush, Philip T.; Pahl, Elfriede; Naftel, David C.; Pruitt, Elizabeth; Everitt, Melanie D.; Missler, Heather; Zangwill, Steven; Burch, Michael; Hoffman, Timothy Michael; Butts, Ryan; Mahle, William T.
In: Journal of Heart and Lung Transplantation, Vol. 35, No. 12, 01.12.2016, p. 1497-1504.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A multi-institutional evaluation of antibody-mediated rejection utilizing the Pediatric Heart Transplant Study database
T2 - Journal of Heart and Lung Transplantation
AU - Thrush, Philip T.
AU - Pahl, Elfriede
AU - Naftel, David C.
AU - Pruitt, Elizabeth
AU - Everitt, Melanie D.
AU - Missler, Heather
AU - Zangwill, Steven
AU - Burch, Michael
AU - Hoffman, Timothy Michael
AU - Butts, Ryan
AU - Mahle, William T.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background Current knowledge of antibody-mediated rejection (AMR) after heart transplantation (HT) stems largely from adult data. Using the Pediatric Heart Transplant Study (PHTS) database, we report the incidence of AMR, describe treatment, and evaluate outcomes for treated AMR in children after HT. Methods We queried the PHTS database for patients <18 years of age undergoing primary HT between January 2010 and December 2014. An AMR episode was defined as either a biopsy consistent with pathologic AMR or a rejection event based on immunotherapy augmentation directed against antibody production. Biopsy data, treatment strategies and survival were analyzed. Results An episode of AMR was identified in 179 of 1,596 (11%) HT recipients and in 246 of 705 (35%) rejection episodes. AMR was diagnosed by biopsy in 182 of 246 episodes and by immunotherapy in 64 of 179 episodes. Mixed rejection was identified in 179. Freedom from AMR was 88% and 82% at 1 and 3 years, respectively. AMR therapies included intravenous immunoglobulin (IVIg) (58%), plasmapheresis (40%), rituximab (40%), bortezomib (11%) and eculizumab (0.4%). The most commonly used combination therapies included IVIg/plasmapheresis/rituximab (13%). Thirty-three patients (16%) died after developing AMR. Patient and graft survival were lower for the AMR+ group. One- and 3-year survival after initial AMR diagnosis was 88% and 77%, respectively. Conclusions In his study we report the largest experience of AMR in pediatric HT recipients. AMR was common and often occurred concurrently with acute cellular rejection. There is wide variability in the treatment of AMR. Short-term patient and graft outcomes were worse for those with treated AMR.
AB - Background Current knowledge of antibody-mediated rejection (AMR) after heart transplantation (HT) stems largely from adult data. Using the Pediatric Heart Transplant Study (PHTS) database, we report the incidence of AMR, describe treatment, and evaluate outcomes for treated AMR in children after HT. Methods We queried the PHTS database for patients <18 years of age undergoing primary HT between January 2010 and December 2014. An AMR episode was defined as either a biopsy consistent with pathologic AMR or a rejection event based on immunotherapy augmentation directed against antibody production. Biopsy data, treatment strategies and survival were analyzed. Results An episode of AMR was identified in 179 of 1,596 (11%) HT recipients and in 246 of 705 (35%) rejection episodes. AMR was diagnosed by biopsy in 182 of 246 episodes and by immunotherapy in 64 of 179 episodes. Mixed rejection was identified in 179. Freedom from AMR was 88% and 82% at 1 and 3 years, respectively. AMR therapies included intravenous immunoglobulin (IVIg) (58%), plasmapheresis (40%), rituximab (40%), bortezomib (11%) and eculizumab (0.4%). The most commonly used combination therapies included IVIg/plasmapheresis/rituximab (13%). Thirty-three patients (16%) died after developing AMR. Patient and graft survival were lower for the AMR+ group. One- and 3-year survival after initial AMR diagnosis was 88% and 77%, respectively. Conclusions In his study we report the largest experience of AMR in pediatric HT recipients. AMR was common and often occurred concurrently with acute cellular rejection. There is wide variability in the treatment of AMR. Short-term patient and graft outcomes were worse for those with treated AMR.
KW - acute cellular rejection
KW - antibody-mediated rejection
KW - heart transplantation
KW - humoral rejection
KW - immunotherapy
KW - pediatrics
KW - rejection
UR - http://www.scopus.com/inward/record.url?scp=85000838080&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85000838080&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2016.06.014
DO - 10.1016/j.healun.2016.06.014
M3 - Article
VL - 35
SP - 1497
EP - 1504
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 12
ER -