Heart transplantation across the antibodies against HLA and ABO.
We have intentionally performed heart transplantation in a 5-year-old child, despite the most unfavourable risk factors for patient survival; the presence of high level of antibodies against donor's human leucocyte antigen (HLA) class I/II and blood group antigens. Pretransplant treatment by mycophenolate mofetil, prednisolone, tacrolimus, intravenous immunoglobulin, rituximab, protein-A immunoadsorption (IA) and plasma exchange reduced antibody titres against the donor's lymphocytes from 128 to 16 and against the donor's blood group antigen from 256 to 0. The patient was urgently transplanted with a heart from an ABO incompatible donor (A(1) to O). A standard triple-drug immunosuppressive protocol was used. No hyperacute rejection was seen. Antibodies against the donor's HLA antigens remained at a low level despite three acute rejections. Rising anti-A(1) blood group antibodies preceded the second rejection and were reduced by two blood group-specific IAs and remained at a low level. The patient is doing well despite the persistence of donor-reactive antibodies.
Bucin
Dragan
D
Transplantation Laboratory, University Hospital Blood Centre, Lund, Sweden. dragan.bucin@skane.se
Johansson
Sune
S
Malm
Torsten
T
Jögi
Peeter
P
Johansson
Jens
J
Westrin
Per
P
Lindberg
Lars O
LO
Olsson
Ann-Kristin
AK
Gelberg
Jan
J
Peres
Valeria
V
Harling
Solweig
S
Bennhagen
Rolf
R
Kornhall
Björn
B
Ekmehag
Björn
B
Kurkus
Jan
J
Otto
Gisela
G
D000017:ABO Blood-Group System / Q000276:immunology*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008214:Lymphocytes / Q000276:immunology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010951:Plasma Exchange; D011239:Prednisolone / Q000627:therapeutic use; D000069283:Rituximab; D013205:Staphylococcal Protein A / Q000276:immunology; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D013205:Staphylococcal Protein A; D000069283:Rituximab; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus