194 The effect of pregnancy on panel-reactive antibody (PRA) in patients with repaired congenital heart disease

Abstract

To demonstrate the effect of pregnancy on panel reactive antibody (PRA) levels in women with repaired congenital heart disease (CHD). This will assess the utility of PRA assessment in reproductive age women and impact decision making regarding pursuit of pregnancy. Prospective observational cohort study of PRA levels in adult women with repaired CHD who have had pregnancies compared to those without pregnancies. Cardiac history and exposures reviewed. Serum PRA level analysis performed using the Luminex platform. A threshold of 25 percent was used to define PRA sensitization. Comparison groups were similar with regard to age, height, weight, prior sexual encounters, number of prior cardiac surgeries and times on cardiopulmonary (CP) bypass. Fontan physiology was analyzed as a prespecified subgroup. There is no significant difference in the rate of PRA sensitization when comparing women with a history of a prior pregnancy to those without a prior pregnancy. No difference in PRA sensitization was found by number of prior parity events. Individual PRA subtypes (I and II) also demonstrate no difference. The subgroup analysis of patients with Fontan physiology showed similar rates of PRA sensitization regardless of pregnancy history. Age is correlated to PRA-2 level (r=0.42, p=0.03). In women with repaired CHD, there is no association between history of pregnancy and rate of PRA sensitization. This study was only powered to detect a 45% difference in the rate of PRA sensitization and cannot exclude a smaller effect size. Future larger prospective and longitudinal studies on the effect of pregnancy events on PRA sensitization on an individual level are important.View Large Image Figure ViewerDownload Hi-res image Download (PPT)