Successful ABO-incompatible heart transplantation in two infants.
In the pediatric age group shortage of donor hearts leads to mortality rates of 30-50% on the waiting list. Because of the immaturity of the immune system of infants, ABO-incompatible heart transplantation may be an option to increase donor availability. We transplanted two infants with blood type O at the age of 7 and 5 months, respectively, with complex congenital heart disease. Intraoperative plasma exchange was performed during cardiopulmonary bypass followed by standard immunosuppression. Both recipients received a blood type A donor organ. Plasma was exchanged up to six times until anti-A antibodies were eliminated. No hyperacute rejection occurred, ventricular function is excellent and there have been no acute rejection episodes up to 4 months after transplantation. Anti-A antibody titers remained low and eventually disappeared. ABO-incompatible cardiac transplantation shows good short-term results in young infants and appears to be a safe procedure to reduce mortality on the waiting list.
Schmoeckel
Michael
M
Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians University, D-81377 Munich, Germany. michael.schmoeckel@med.uni-muenchen.de
Däbritz
Sabine H
SH
Kozlik-Feldmann
Rainer
R
Wittmann
Georg
G
Christ
Frank
F
Kowalski
Christian
C
Meiser
Bruno M
BM
Netz
Heinrich
H
Reichart
Bruno
B
D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006331:Heart Diseases / Q000628:therapy; D016027:Heart Transplantation / Q000379:methods*; D006388:Hemagglutinins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007223:Infant; D008297:Male; D013997:Time Factors
D000017:ABO Blood-Group System; D006388:Hemagglutinins; D007166:Immunosuppressive Agents