Much like how a vaccine engages the immune system to fight off a virus, a transplanted organ can cause antibodies to fight off foreign tissue. For this reason, experts have long suggested children with these antibodies should wait for a “perfect match” that will not activate the antibody response. Now, new research suggests these children should receive a heart transplant as soon as a suitable donor is available.
The research – led by Dr. Brian Feingold of the Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine in Pennsylvania – was recently presented at the American Heart Association’s (AHA) Scientific Sessions 2014.
Though experts have long advocated the waiting approach to heart transplants, Dr. Feingold says patients with antibodies in their blood are at high risk while waiting for their perfect match. He adds that 20% of children waiting for a heart transplant may have these antibodies.
What is more, the AHA note that as of June 2013, nearly 3,500 patients were waiting for a heart transplant.
A patient may need a heart transplant for several reasons, including improperly functioning ventricles or heart failure. When a child receives one, the transplanted heart grows to adult size as the child grows.
He or she will then need to take immunosuppressive medications and other medicine for the rest of their life in order to control transplant side effects.
To investigate whether waiting or speedy heart transplants are better, the researchers looked at data on over 2,700 children – of an average age of 5 years old – who were listed for transplant since 1999.
The patient data came from the Organ Procurement and Transplantation Network, and cost data was obtained from the Children’s Hospital of Pittsburgh of UPMC and the public Healthcare Cost Utilization Project Kids’ Inpatient Database.
Of these children, more than 50% were white, 23% were black and 15% were Hispanic. Additionally, around half of the children were born with heart disease and all needed an urgent heart transplant.
The team then compared 10-year survival rates among two groups: those who waited for a donor heart without any conflicting antibodies and those who took the first suitable offer, regardless of potential antibody issues.
Results showed that those who took the first suitable offer had increased survival by more than 1 year, compared with those who waited for a perfect match. Additionally, accepting the first offer cost an average of $122,856 less than waiting.
The researchers note that they were able to control for antibody status, wait-list time and survival, and costs, however, they did not analyze rejection rates or treatment other than heart transplant.
Dr. Feingold says their study shows that “denial of listing for transplant, solely on the basis of having too many antibodies, is unwarranted,” and adds:
”One of the next questions is whether low levels of antibodies identified using modern antibody detection techniques are clinically meaningful. Are they a harbinger of problems to come, or just a ‘false positive’ that potentially alters our care of patients with important effects on survival and costs of care?”
In October of this year, Medical News Today reported on a study that suggested lungs from donors who die from drowning and asphyxiation may be safe for transplant.