title: Abo-incompatible heart transplantation in infants: the Freeman Hospital experience.
abstract: BACKGROUND
  Incompatibility of the major blood groups A, B, and O has been an absolute contraindication for heart transplantation. However, because of immunologic immaturity, infants may have relative protection from hyperacute rejection and thus could undergo transplantation with ABO-mismatched organs.
  
  
  METHODS
  Since January 2000, the authors have adopted a policy of considering infants for ABO-incompatible heart transplantation. Serum isohemagglutinin titers were measured before, during, and after transplantation. Two infants (3 and 2 months old) and a 21-month-old child underwent ABO-incompatible heart transplantation. During cardiopulmonary bypass, plasma exchange was performed. No other antibody-removal procedures were performed. A routine immunosuppressive regimen was used, and rejection was monitored by endomyocardial biopsies. An additional two patients (31 and 18 months old) were worked up but were unsuitable for ABO-incompatible transplantation because of high isohemagglutinin titers. They were successfully bridged to transplantation and received heart transplants from ABO-compatible donors.
  
  
  RESULTS
  All three infants with ABO-incompatible heart transplants are fit and well, 40 months, 30 months, and 12 months postoperatively. All three had serum antibodies to antigens of the donor's blood group before transplantation. No hyperacute rejection occurred. No morbidity attributable to the ABO incompatibility has been observed.
  
  
  CONCLUSIONS
  ABO-mismatched heart transplantation may be undertaken safely and without any short-term adverse consequences in infants and young children in whom isohemagglutinin production is not yet established.
authors.affiliation: Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom. jagan.rao@nuth.northy.nhs.uk
authors.forename: Jagan N
authors.initials: JN
authors.lastname: Rao
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
authors.forename: John R L
authors.initials: JR
authors.lastname: Hamilton
authors.forename: David
authors.initials: D
authors.lastname: Bolton
authors.forename: Simon
authors.initials: S
authors.lastname: Haynes
authors.forename: Johnathan H
authors.initials: JH
authors.lastname: Smith
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wallis
authors.forename: Patrick
authors.initials: P
authors.lastname: Kesteven
authors.forename: Kamran
authors.initials: K
authors.lastname: Khattak
authors.forename: John
authors.initials: J
authors.lastname: O'Sullivan
authors.forename: John H
authors.initials: JH
authors.lastname: Dark
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000367:Age Factors; D000906:Antibodies / Q000097:blood; D000075202:Contraindications; D005260:Female; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006388:Hemagglutinins / Q000276:immunology; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D007107:Immune System / Q000254:growth & development* / Q000276:immunology; D007223:Infant; D008297:Male; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies; D006388:Hemagglutinins