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#66-OR
LACK OF HLA MATCHING FOR VALVE ALLOGRAFTS INCREASES THE RISK OF SENSITIZATION: A PROBLEM FOR FUTURE CARDIAC TRANSPLANTATION.
P. Campbell, MBChB, S. Meyer, MD, J. Rutledge, MD, J. Brinded, MLT, A. Halpin, MsC, L. Hawkins, J. Lakey, MD and D. Ross, MD. Edmonton AB, Canada, University of Alberta, T6G 2B7, Histocompatibility Laboratory; Edmonton AB, Canada, University of Alberta, T6G 2B7, Dept of Surgery and Edmonton AB, Canada, University of Alberta, T6G 2B7, Cardiology, Dept of Pediatrics.
The Norwood operation is the standard of care for hypoplastic left heart syndrome. This requires the use of an allograft cryopreserved pulmonary artery patch to reconstruct the aorta. We set out to determine the risk of sensitization following the Norwood procedure and to compare this to children who also underwent heart surgery and received blood products, but had no allograft. Blood was drawn at the time of surgery and at 1, 4, 12 months post operatively. Donor and recipient typing was performed if possible.
We report the four month data. 8/8 allograft recipients are sensitized whereas none of the control group have antibodies. The allograft recipients received more red cells (p=0.001) and cryoprecipitate (p=0.011) than the control group. HLA matching appears to affect the degree of sensitization (table 1). We recommend matching donor and recipient whenever possible to minimize sensitization in the liklihood of future cardiac transplantation.
Summary of donor and recipient typing and PRA Patient typing donor typing PRA I PRA II Donor specific antibody N/A A1,A24,B8,B40,DR1,DR13 63 85 A24,B8,B40,DR1,DR3 A24,A32,B35,B51,DR11,DR10 A1,A29,B8,B44,DR3,DR7 99 82 A1.A29,B8,B44,DR7 A2,A66,B7,B41,DR103,DR13 A2,A11,B27,B61,DR1,DR13 78 19 A11,B27,DR1 A1,A3,B8,B18,DR17,DR8 A2,B7,14,CR7,DR15 99 59 A2,B7,DR7,DR15 A2,A3,B7,B35,DR11,DR4 A2,B7,B35,DR1,DR15 0 67 DR1,DR15 A2,A26,B60,B56,DR4,DR14 N/A 100 100 N/A A1,A66,B8,B41,DR17,DR7 A3,B35,B44,DR7,DR14 31 3 A3,B35 A1,A3,B7,B8,DR1,DR7 A2,B7,B64,DR7,DR13 65 85 A2,DR13