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What place do "saviour siblings" have in paediatric transplantation: establishing the role of pre-implantation genetic diagnosis with HLA typing
  1. Gabrielle N Samuel (gsamuel{at}med.usyd.edu.au)
  1. Universtiy of Sydney, Australia
    1. Kimberly A Strong (kstrong{at}med.usyd.edu.au)
    1. Universtiy of Sydney, Australia
      1. Ian Kerridge (kerridge{at}med.usyd.edu.au)
      1. Universtiy of Sydney, Australia
        1. Christopher FC Jordens (cjordens{at}med.usyd.edu.au)
        1. Universtiy of Sydney, Australia
          1. Rachel Ankeny (rachel.ankeny{at}adelaide.edu.au)
          1. Universtiy of Sydney, Australia
            1. Peter J Shaw (peters{at}chw.edu.au)
            1. Haematology Department, Westmead Hospital, Australia

              Abstract

              Background: Not all children in need of a haematopoietic stem cell transplant have a suitable relative or unrelated donor available. Recently, in vitro fertilization (IVF) with pre-implantation genetic diagnosis (PGD) for human leukocyte antigen (HLA) tissue typing has been used to selectively transfer an IVF embryo in order to produce a child who may provide umbilical cord blood for transplantation to an ill sibling. Such children are sometimes called "saviour siblings".

              Objective: To examine the published clinical and epidemiological evidence relevant to the use of this technology, with the aim of clarifying those situations where IVF and PGD for HLA-typing should be discussed with parents of an ill child.

              Design: A critical analysis of published literature on: comparative studies of umbilical cord blood versus other sources of stem cells for transplantation; comparative studies of matched unrelated donor versus matched related donor transplantation; and the likelihood of finding an unrelated stem cell donor.

              Conclusion: IVF and PGD for HLA-typing is only applicable when transplantation is non-urgent and parents are of reproductive age. Discussions regarding this technology may be appropriate where no suitable related or unrelated donor is available for a child requiring a transplant, or where no suitable related donor is available and transplantation is only likely to be entertained with a matched sibling donor. Discussion may also be considered in the management of any child lacking a matched related donor who requires a non-urgent transplant or may require a transplant in the future.

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