Successful management of a B-type cardiac allograft into an O-type man with 3(1/2)-year clinical follow-up.
BACKGROUND
In May 1997, a 19-year-old male patient of histo-blood group type O suffering from congenital end-stage heart failure accidentally received a cardiac allograft of type B and is still alive in fair condition.


METHODS
In addition to conventional immunosuppressive therapy, plasma exchange (PEX), extracorporeal immunoabsorption (EIA), intravenous immunoglobulins (IVIG), and C1 inhibitor were used.


RESULTS
Such treatment successfully reduced both IgM and IgG anti-B levels and complement hyperactivity and allowed to reach the state of accommodation without obvious signs of rejection. The patient has been surviving for 42 months; retransplantation with an O-type heart remained unnecessary.


CONCLUSIONS
Humoral rejection has been avoided in this patient, with PEX, EIA, IVIG, and C1 inhibitor substantially contributing to this success. With future availability of such combined therapies, preferably before transplantation, vascular rejection events caused by preformed antibodies and complement (ABO mismatch or anti-HLA) could be prevented or treated.
Mohacsi
P
P
Department of Cardiology, University Hospital / Inselspital, Bern, Switzerland. paul.mohacsi@insel.ch
Rieben
R
R
Sigurdsson
G
G
Tschanz
H
H
Schaffner
T
T
Nydegger
U E
UE
Carrel
T
T
D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility; D002303:Cardiac Output, Low / Q000151:congenital / Q000601:surgery; D003172:Complement C1 / Q000187:drug effects; D003169:Complement Inactivator Proteins / Q000627:therapeutic use; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010951:Plasma Exchange; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D003172:Complement C1; D003169:Complement Inactivator Proteins; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents