Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation

Background Allosensitization is associated with inferior waitlist outcomes in pediatric heart transplant candidates, presumably because of the requirement for a negative prospective crossmatch. However, there are no reports of heart transplant candidate outcomes according to prospective crossmatch r...

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Veröffentlicht in:The Journal of heart and lung transplantation 2013-01, Vol.32 (1), p.56-62
Hauptverfasser: Feingold, Brian, MD, MS, Park, Seo Young, PhD, Comer, Diane M., BA, Moore, Charity G., PhD, Webber, Steven A., MBChB, Bryce, Cindy L., PhD
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container_end_page 62
container_issue 1
container_start_page 56
container_title The Journal of heart and lung transplantation
container_volume 32
creator Feingold, Brian, MD, MS
Park, Seo Young, PhD
Comer, Diane M., BA
Moore, Charity G., PhD
Webber, Steven A., MBChB
Bryce, Cindy L., PhD
description Background Allosensitization is associated with inferior waitlist outcomes in pediatric heart transplant candidates, presumably because of the requirement for a negative prospective crossmatch. However, there are no reports of heart transplant candidate outcomes according to prospective crossmatch requirements. Methods We analyzed data on all children listed for isolated heart transplantation from 1995 to 2009 in the USA according to prospective crossmatch requirement (PXMR). Primary objectives were to describe the prevalence of PXMR at and during listing and to compare waitlist and post-transplant survival for patients based on PXMR. Patients with a PXMR during listing include those with a PXMR at the time of listing as well as those who were designated by the listing center as needing a prospective crossmatch at some point after being placed onto the waitlist. Results Among 6,343 listed children, 7.7% had a requirement for a prospective crossmatch at the time of listing and 11.8% had a requirement for a prospective crossmatch during listing. After controlling for risk factors associated with inferior survival, PXMR at listing was associated with increased waitlist mortality (HR 1.32, 95% CI 1.10 to 1.56; p = 0.003). Recipients with a PXMR during listing more commonly had a positive DSXM (22.1% vs 10.3%, p < 0.0001), as did recipients who carried a PXMR throughout listing (21.7% vs 11.3%, p = 0.004). However, there was no significant difference in post-transplant survival on the basis of a PXMR during listing (HR 1.04, 95% CI 0.87 to 1.25; p = 0.67). Nearly 30% of recipients with a PXMR during listing had a peak pre-transplant PRA≤10%. Conclusions PXMR increases the likelihood of death while awaiting, but not after, pediatric heart transplantation. Further study is necessary to understand how PXMR is applied, and changes, after listing for pediatric heart transplantation.
doi_str_mv 10.1016/j.healun.2012.09.023
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However, there are no reports of heart transplant candidate outcomes according to prospective crossmatch requirements. Methods We analyzed data on all children listed for isolated heart transplantation from 1995 to 2009 in the USA according to prospective crossmatch requirement (PXMR). Primary objectives were to describe the prevalence of PXMR at and during listing and to compare waitlist and post-transplant survival for patients based on PXMR. Patients with a PXMR during listing include those with a PXMR at the time of listing as well as those who were designated by the listing center as needing a prospective crossmatch at some point after being placed onto the waitlist. Results Among 6,343 listed children, 7.7% had a requirement for a prospective crossmatch at the time of listing and 11.8% had a requirement for a prospective crossmatch during listing. After controlling for risk factors associated with inferior survival, PXMR at listing was associated with increased waitlist mortality (HR 1.32, 95% CI 1.10 to 1.56; p = 0.003). Recipients with a PXMR during listing more commonly had a positive DSXM (22.1% vs 10.3%, p &lt; 0.0001), as did recipients who carried a PXMR throughout listing (21.7% vs 11.3%, p = 0.004). However, there was no significant difference in post-transplant survival on the basis of a PXMR during listing (HR 1.04, 95% CI 0.87 to 1.25; p = 0.67). Nearly 30% of recipients with a PXMR during listing had a peak pre-transplant PRA≤10%. Conclusions PXMR increases the likelihood of death while awaiting, but not after, pediatric heart transplantation. Further study is necessary to understand how PXMR is applied, and changes, after listing for pediatric heart transplantation.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2012.09.023</identifier><identifier>PMID: 23157944</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>allosensitization ; Blood Grouping and Crossmatching - statistics &amp; numerical data ; Child ; Child, Preschool ; crossmatch ; Female ; Heart Transplantation ; Humans ; Male ; pediatric ; Surgery ; Treatment Outcome ; Waiting Lists</subject><ispartof>The Journal of heart and lung transplantation, 2013-01, Vol.32 (1), p.56-62</ispartof><rights>International Society for Heart and Lung Transplantation</rights><rights>2013 International Society for Heart and Lung Transplantation</rights><rights>Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.</rights><rights>2013 International Society for Heart and Lung Transplantation. All rights reserved. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-1a8b7bdfebfc0aeb3bce30e7e886992e37c3bc63e7e2441d2aa7bf48e1200c283</citedby><cites>FETCH-LOGICAL-c518t-1a8b7bdfebfc0aeb3bce30e7e886992e37c3bc63e7e2441d2aa7bf48e1200c283</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.healun.2012.09.023$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23157944$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feingold, Brian, MD, MS</creatorcontrib><creatorcontrib>Park, Seo Young, PhD</creatorcontrib><creatorcontrib>Comer, Diane M., BA</creatorcontrib><creatorcontrib>Moore, Charity G., PhD</creatorcontrib><creatorcontrib>Webber, Steven A., MBChB</creatorcontrib><creatorcontrib>Bryce, Cindy L., PhD</creatorcontrib><title>Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Background Allosensitization is associated with inferior waitlist outcomes in pediatric heart transplant candidates, presumably because of the requirement for a negative prospective crossmatch. However, there are no reports of heart transplant candidate outcomes according to prospective crossmatch requirements. Methods We analyzed data on all children listed for isolated heart transplantation from 1995 to 2009 in the USA according to prospective crossmatch requirement (PXMR). Primary objectives were to describe the prevalence of PXMR at and during listing and to compare waitlist and post-transplant survival for patients based on PXMR. Patients with a PXMR during listing include those with a PXMR at the time of listing as well as those who were designated by the listing center as needing a prospective crossmatch at some point after being placed onto the waitlist. Results Among 6,343 listed children, 7.7% had a requirement for a prospective crossmatch at the time of listing and 11.8% had a requirement for a prospective crossmatch during listing. After controlling for risk factors associated with inferior survival, PXMR at listing was associated with increased waitlist mortality (HR 1.32, 95% CI 1.10 to 1.56; p = 0.003). Recipients with a PXMR during listing more commonly had a positive DSXM (22.1% vs 10.3%, p &lt; 0.0001), as did recipients who carried a PXMR throughout listing (21.7% vs 11.3%, p = 0.004). However, there was no significant difference in post-transplant survival on the basis of a PXMR during listing (HR 1.04, 95% CI 0.87 to 1.25; p = 0.67). Nearly 30% of recipients with a PXMR during listing had a peak pre-transplant PRA≤10%. Conclusions PXMR increases the likelihood of death while awaiting, but not after, pediatric heart transplantation. Further study is necessary to understand how PXMR is applied, and changes, after listing for pediatric heart transplantation.</description><subject>allosensitization</subject><subject>Blood Grouping and Crossmatching - statistics &amp; numerical data</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>crossmatch</subject><subject>Female</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Male</subject><subject>pediatric</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Waiting Lists</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUstu1TAQjRAVLYU_QMhLNgl-5LlBQhVQpEpd0K4tx5n0ziWxU9u5Vf-eub1teWxYeTSeOXPmnMmyd4IXgov647bYgJlWV0guZMG7gkv1IjsRVdXkSojmJcW8Urksu_Y4ex3jlnMqqeSr7FgqUTVdWZ5keLkm62eIzIwJApswJnQ37A7ThhkW4HbFADO4xEYfKLMEHxewCXfALMVxNsluGDq2wIAmBbSMiIXEUjAuLpNxyST07k12NJopwtvH9zS7_vrl6uw8v7j89v3s80VuK9GmXJi2b_phhH603ECveguKQwNtW3edBNVYStWKMrIsxSCNafqxbEFIzq1s1Wn26YC7rP0MgyXqwUx6CTibcK-9Qf33j8ONvvE7rWquVK0I4MMjQPC3K8SkZ4wWJtoE_Bq1kI0qq65WkkrLQ-mDEgHG5zGC671LeqsPLum9S5p3miygtvd_UnxuerLl9w5AQu0Qgo4WwVlSOJD2evD4vwn_AtgJHVoz_YR7iFu_BkcmaKEj9egf-0vZHwqJKBQva_UL-q2-pg</recordid><startdate>20130101</startdate><enddate>20130101</enddate><creator>Feingold, Brian, MD, MS</creator><creator>Park, Seo Young, PhD</creator><creator>Comer, Diane M., BA</creator><creator>Moore, Charity G., PhD</creator><creator>Webber, Steven A., MBChB</creator><creator>Bryce, Cindy L., PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130101</creationdate><title>Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation</title><author>Feingold, Brian, MD, MS ; Park, Seo Young, PhD ; Comer, Diane M., BA ; Moore, Charity G., PhD ; Webber, Steven A., MBChB ; Bryce, Cindy L., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-1a8b7bdfebfc0aeb3bce30e7e886992e37c3bc63e7e2441d2aa7bf48e1200c283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>allosensitization</topic><topic>Blood Grouping and Crossmatching - statistics &amp; numerical data</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>crossmatch</topic><topic>Female</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Male</topic><topic>pediatric</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Waiting Lists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feingold, Brian, MD, MS</creatorcontrib><creatorcontrib>Park, Seo Young, PhD</creatorcontrib><creatorcontrib>Comer, Diane M., BA</creatorcontrib><creatorcontrib>Moore, Charity G., PhD</creatorcontrib><creatorcontrib>Webber, Steven A., MBChB</creatorcontrib><creatorcontrib>Bryce, Cindy L., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feingold, Brian, MD, MS</au><au>Park, Seo Young, PhD</au><au>Comer, Diane M., BA</au><au>Moore, Charity G., PhD</au><au>Webber, Steven A., MBChB</au><au>Bryce, Cindy L., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2013-01-01</date><risdate>2013</risdate><volume>32</volume><issue>1</issue><spage>56</spage><epage>62</epage><pages>56-62</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Background Allosensitization is associated with inferior waitlist outcomes in pediatric heart transplant candidates, presumably because of the requirement for a negative prospective crossmatch. However, there are no reports of heart transplant candidate outcomes according to prospective crossmatch requirements. Methods We analyzed data on all children listed for isolated heart transplantation from 1995 to 2009 in the USA according to prospective crossmatch requirement (PXMR). Primary objectives were to describe the prevalence of PXMR at and during listing and to compare waitlist and post-transplant survival for patients based on PXMR. Patients with a PXMR during listing include those with a PXMR at the time of listing as well as those who were designated by the listing center as needing a prospective crossmatch at some point after being placed onto the waitlist. Results Among 6,343 listed children, 7.7% had a requirement for a prospective crossmatch at the time of listing and 11.8% had a requirement for a prospective crossmatch during listing. After controlling for risk factors associated with inferior survival, PXMR at listing was associated with increased waitlist mortality (HR 1.32, 95% CI 1.10 to 1.56; p = 0.003). Recipients with a PXMR during listing more commonly had a positive DSXM (22.1% vs 10.3%, p &lt; 0.0001), as did recipients who carried a PXMR throughout listing (21.7% vs 11.3%, p = 0.004). However, there was no significant difference in post-transplant survival on the basis of a PXMR during listing (HR 1.04, 95% CI 0.87 to 1.25; p = 0.67). Nearly 30% of recipients with a PXMR during listing had a peak pre-transplant PRA≤10%. Conclusions PXMR increases the likelihood of death while awaiting, but not after, pediatric heart transplantation. Further study is necessary to understand how PXMR is applied, and changes, after listing for pediatric heart transplantation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23157944</pmid><doi>10.1016/j.healun.2012.09.023</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; ScienceDirect Journals (5 years ago - present)
subjects allosensitization
Blood Grouping and Crossmatching - statistics & numerical data
Child
Child, Preschool
crossmatch
Female
Heart Transplantation
Humans
Male
pediatric
Surgery
Treatment Outcome
Waiting Lists
title Outcomes after listing with a requirement for a prospective crossmatch in pediatric heart transplantation
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