{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T20:23:22Z","timestamp":1775852602070,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11_supplement","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2007,9,11]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            There is an elevated risk for poor outcomes after heart transplant (HTx) in patients sensitized to human leukocyte antigens including graft dysfunction, acute cellular and antibody-mediated (AMR) rejection, and cardiac allograft vasculopathy. We report our experience with human leukocyte antigens\u2013sensitized pediatric HTx recipients.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            We identified pediatric HTx patients with elevated pre-HTx Panel Reactive Antibody (Class I\/II; &gt;10%), or a positive T- or B-cell crossmatch. Thirteen patients met criteria (5 female, 39%). The median age at HTx was 7 months (3.5 months to 15.5 years). Nine were infants who had prior palliation for congenital heart disease. Four were older patients (median 7.3 years; 4.8 to 15.5 years): 2 had congenital heart disease (Fontan), 2 were re-HTx. B-cell therapies were used in all patients, guided by assessment of CD19+ and CD20+ cells. Immunosuppression included thymoglobulin induction, and tacrolimus, mycophenolate mofetil, and steroids. Daily plasmapheresis \u00b1 intravenous immunoglobulin G was used if there was a positive crossmatch on day 1, with a gradual, biopsy-guided weaning schedule. Rituximab was used when AMR was detected on biopsy: more recently (n=3), used empirically perioperatively. AMR was confirmed in 9 patients within median 0.9 months post-HTx. Seven had early acute cellular rejection (\u2265 ISHLT Grade 2 R) with no hemodynamic compromise or graft dysfunction. There were 4 deaths post-HTx (range, 11 days to 9 months). The median follow-up of 9 survivors was 1.7 years (0.3 to 3.7 years). Of 7 patients &gt;6 months post-HTx, no AMR or cardiac allograft vasculopathy was observed at a mean of 1.9+1.1 years post-HTx and no cardiac allograft vasculopathy.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            Despite aggressive management, acute cellular rejection and AMR occurred frequently early post-HTx. An algorithm of B cell\u2013directed strategies can be effective in managing these patients with reasonable intermediate-term outcomes.\n          <\/jats:p>","DOI":"10.1161\/circulationaha.107.709022","type":"journal-article","created":{"date-parts":[[2007,9,10]],"date-time":"2007-09-10T20:58:24Z","timestamp":1189457904000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Pediatric Heart Transplantation in Human Leukocyte Antigen\u2013Sensitized Patients"],"prefix":"10.1161","volume":"116","author":[{"given":"Stacey M.","family":"Pollock-BarZiv","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"den Hollander","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo-Yee","family":"Ngan","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Kantor","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"McCrindle","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori J.","family":"West","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne I.","family":"Dipchand","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics (S.M.P.-B., P.K., B.M., A.I.D.), Division of Cardiology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; Histocompatibility Laboratory (N.d.H.), University Health Network, Toronto, Ontario, Canada; Department of Pediatrics (B.-Y.N.), Division of Pathology, The Hospital for Sick Children\/University of Toronto, Toronto, Ontario, Canada; and Departments of Pediatrics, Surgery, and Immunology (L.J.W.), University of Alberta, Edmonton,..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.03.031"},{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-0012.17.s9.3.x"},{"key":"e_1_3_3_3_2","first-page":"S167.","volume":"23","year":"2005","unstructured":"Mahle WT, Naftel DC, Rusconi P, Edens RE, Shaddy RE; Pediatric Heart Transplant Study Group. 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