The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1402-1408, June 2010

Glutaraldehyde treatment of allograft tissue decreases allosensitization after the Norwood procedure

  • Bryce J. Laing, MD

      Affiliations

    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • David B. Ross, MD

      Affiliations

    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Steven R. Meyer, MD, PhD

      Affiliations

    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Patricia Campbell, MBChB

      Affiliations

    • Department of Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Anne M. Halpin, MSc

      Affiliations

    • Department of Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Lori J. West, MD, DPhil

      Affiliations

    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Ivan M. Rebeyka, MD

      Affiliations

    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • Corresponding Author InformationAddress for reprints: Ivan M. Rebeyka, MD, 3H2.06 WCM Health Sciences Centre, Edmonton, AB T6G 2B7, Canada.

Received 8 September 2009; received in revised form 26 November 2009; accepted 19 December 2009. published online 17 March 2010.

Objective

Cryopreserved allograft tissue used in the Norwood procedure for infants with hypoplastic left heart syndrome causes a marked immunologic sensitization that may complicate future heart transplantation. Treatment of the allograft tissue before implantation may prevent this sensitization. The purpose of this study was to assess the anti-human leukocyte antigen antibody response to glutaraldehyde-treated allograft tissue used in the repair of hypoplastic left heart syndrome.

Methods

Since June 2005, the University of Alberta has subjected allograft vascular tissue used in the Norwood procedure to glutaraldehyde treatment. An observational study was designed to assess whether glutaraldehyde treatment of the allograft tissue affected subsequent panel reactive antibody after patch implantation. Panel reactive antibodies for class I (human leukocyte antigen-A, B, C) and class II (human leukocyte antigen-DR, DQ) antibodies were measured 4 months postoperatively using flow cytometry.

Results

Fourteen patients underwent a Norwood procedure using glutaraldehyde-treated allograft tissue. Historical controls consisted of 12 patients who underwent a Norwood procedure using untreated allograft tissue. At 4 months, infants who had received glutaraldehyde-treated allograft tissue had lower class I panel reactive antibody (7.3% ± 17.4% [median, 0%] vs 61.9% [median, 73%] ± 39.9%; P = .0005) and class II panel reactive antibody (6.1% [median, 0%] ± 22.7% vs 49.3% [median, 63%] ± 41.9%, P = .001) compared with the historical controls.

Conclusion

Intraoperative glutaraldehyde treatment of allograft tissue used in hypoplastic left heart syndrome repair prevents the profound immunologic sensitization that occurs in the majority of infants undergoing surgical palliation. In patients requiring subsequent heart transplantation, this decreases the risk of antibody-mediated rejection and increases the likelihood of finding a suitable donor, thus improving access to transplantation.

Abbreviations and Acronyms: cPRA, calculated panel reactive antibody, HLA, human leukocyte antigen, HLHS, hypoplastic left heart syndrome, PRA, panel reactive antibody

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 Funding: Stollery Children's Hospital Foundation; Dr West's research is supported in part through US National Institutes of Health (Grant HL79067), Canadian Institutes for Health Research, Heart and Stroke Foundation of Canada, and Alberta Heritage Foundation for Medical Research.

 Disclosures: None

PII: S0022-5223(09)01679-1

doi:10.1016/j.jtcvs.2009.12.034

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1402-1408, June 2010

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