Crossing the ABO barrier in infant heart transplantation at the Hospital for Sick Children.
Heart transplantation in infancy is generally associated with excellent clinical results. Unfortunately, heart transplantation cannot be offered to many infants who would benefit from this therapy due to a shortage of organ donors of suitable size for infants, and traditional limitations that constrain donor availability still further, such as the requirement for ABO-compatibility. At the Hospital for Sick Children, we questioned the need to apply this requirement to infants, based on available scientific evidence regarding the immaturity of certain immune responses. Our experience with 23 ABO-incompatible infant heart transplants demonstrates that this procedure can be performed safely in infants. Moreover, we have shown that donor-specific B-cell tolerance develops following ABO-incompatible transplantation. The consistency of the clinical and laboratory outcomes of ABO-incompatible infant heart transplantation to date would suggest that there is no scientific rationale to require ABO-compatibility between donors and recipients for infant transplantation.
West
L J
LJ
Heart Transplant Program, Hospital for Sick Children, Toronto, Canada.
D000017:ABO Blood-Group System / Q000276:immunology*; D006084:Graft Rejection / Q000175:diagnosis; D016027:Heart Transplantation / Q000276:immunology* / Q000379:methods / Q000401:mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D007231:Infant, Newborn; D007518:Isoantibodies / Q000096:biosynthesis; D009864:Ontario / Q000453:epidemiology; D018579:Patient Selection; D015996:Survival Rate; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D007518:Isoantibodies