title: Heart transplantation across the antibodies against HLA and ABO.
abstract: 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.
authors.affiliation: Transplantation Laboratory, University Hospital Blood Centre, Lund, Sweden. dragan.bucin@skane.se
authors.forename: Dragan
authors.initials: D
authors.lastname: Bucin
authors.forename: Sune
authors.initials: S
authors.lastname: Johansson
authors.forename: Torsten
authors.initials: T
authors.lastname: Malm
authors.forename: Peeter
authors.initials: P
authors.lastname: Jögi
authors.forename: Jens
authors.initials: J
authors.lastname: Johansson
authors.forename: Per
authors.initials: P
authors.lastname: Westrin
authors.forename: Lars O
authors.initials: LO
authors.lastname: Lindberg
authors.forename: Ann-Kristin
authors.initials: AK
authors.lastname: Olsson
authors.forename: Jan
authors.initials: J
authors.lastname: Gelberg
authors.forename: Valeria
authors.initials: V
authors.lastname: Peres
authors.forename: Solweig
authors.initials: S
authors.lastname: Harling
authors.forename: Rolf
authors.initials: R
authors.lastname: Bennhagen
authors.forename: Björn
authors.initials: B
authors.lastname: Kornhall
authors.forename: Björn
authors.initials: B
authors.lastname: Ekmehag
authors.forename: Jan
authors.initials: J
authors.lastname: Kurkus
authors.forename: Gisela
authors.initials: G
authors.lastname: Otto
mesh_terms: 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
chemical_list: 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