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Xenoreactive antibody response following pulmonary valve replacement using porcine bioprosthesis in the young


Xenoreactive antibody reaction is known to initiate the immune-mediated valve destruction. To investigate the immune effect, serum anti-α-Gal antibody response following the pulmonary bioprosthesis implantation, including clinical factors, immunoglobulin types and patterns that might influence the anti-α-Gal immune response in children and young adults were studied.


Between January 2008 and February 2011, 40 patients underwent pulmonary valve replacement using a porcine bioprosthesis at an age younger than 30 years. There were 27 males (67.5%), and the median age at operation was 14 years (1.1–27.3 years). Serum was obtained from each patient prior to the operation, 1 day after the operation, at discharge, and at the first and second outpatient clinic visits. These samples were analyzed with an enzyme-linked immunosorbent assay.


Regardless of the isotype, anti-α-Gal antibody activity was increased at discharge and at the first outpatient visit. Although anti-α-Gal IgG antibody activity remained increased by the second outpatient visit, anti-α-Gal IgM antibody activity did not. Anti-α-Gal IgG antibody activity was higher at discharge among patients younger than 15 years. Anti-α-Gal IgG antibody activity were more prominent at the second outpatient visit in non-blood group B patients (A, O).


The implantation of a porcine bioprosthesis elicits an increased formation of anti-α-Gal antibodies, with different patterns of IgM and IgG isotypes in children and young adults. Patient’s age and ABO blood group may influence the patterns of anti-α-Gal immune response after pulmonary valve replacement.

The early postoperative xenoreactive immune response could be considered to influence the initial process of degenerative valve failure.

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Correspondence to MS Kim.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kim, M., Kim, Y., Lim, H. et al. Xenoreactive antibody response following pulmonary valve replacement using porcine bioprosthesis in the young. J Cardiothorac Surg 8 (Suppl 1), O138 (2013).

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