Contemporary outcomes of pediatric cardiac transplantation with a positive retrospective crossmatch

Abstract

AbstractBackgroundA positive crossmatch (+ XM) has traditionally been associated with adverse outcomes following pediatric heart transplantation. However, more recent studies suggest that favorable intermediate‐term outcomes may be achieved despite a + XM. This study's hypothesis is that children with a + XM have similar long‐term survival, but higher rate of complications such as rejection, coronary allograft vasculopathy (CAV), and infection, compared to patients with a negative (−) XM.MethodsThe Pediatric Heart Transplant Society Registry (PHTS) database was queried from 2010–2021 for all patients <18 years of age with a known XM. Baseline demographics were compared between + XM and − XM groups using appropriate parametric and non‐parametric group comparisons. Cox Proportional Hazards Modeling was used to identify risk factors for post‐transplant graft loss, rejection, and CAV.ResultsOf 4599 pediatric heart transplants during the study period, XM results were available for 3914 (85%), of which 373 (9.5%) had a + XM. Univariate analysis showed lower 10‐year survival for patients with + XM (HR = 1.3, p = .04). Multivariate analyses revealed no significant difference in 10‐year survival in the 2 groups; however, time to first rejection (p = .0001) remained significantly shorter in the + XM group.ConclusionsPediatric patients transplanted across a + XM experience earlier rejection; however, after multivariate adjustment, + XM is not independently associated with intermediate‐term graft loss. The risk of heart transplantation against a + XM must be balanced with the ongoing risk of waitlist mortality.