title: Blood type incompatible cardiac transplantation in young infants.
abstract: OBJECTIVE
  Donor organ shortage in pediatric heart transplantation (HTx) is causing mortality rates of 30-50% on the waiting list. Due to immaturity of the immune system of newborns and infants, ABO-incompatible HTx may be an option to increase donor availability. We present our experience with ABO-incompatible HTx.
  
  
  METHODS
  Three infants were transplanted ABO-incompatible since 12/2004: (1) hypoplastic left heart complex, (2) restrictive hypertrophic cardiomyopathy, (3) dilative cardiomyopathy. Age at HTx was 7, 5, and 3.5 months. All recipients had blood type O, donors were A, A, and B. Informed consent was given by parents, the ethics committee, and Eurotransplant.
  
  
  RESULTS
  Preoperative isohemagglutinin titers were low (Patient 1: 1:4 for anti-A1, A2, B, Patient 2: 1:4, 1:1, 1:4 for anti-A1, A2, B, respectively, and Patient 3: 0 for all, but quick spin 1+ for all). Intraoperatively, plasma was separated from red blood cells and discarded up to six times until antibodies were eliminated. Immunosuppressive induction with ATG was started for 5 days. Basic immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisone. Extubation was performed on days 15, 2, and 1, respectively. After a follow-up of 17, 16, and 12 months all patients are well, ventricular function is excellent without any acute rejection periods; Patient 1 is still on dialysis. Isohemagglutinin titers against donor blood type have disappeared in follow-up.
  
  
  CONCLUSIONS
  ABO-incompatible cardiac transplantation shows good short-term results in young infants and seems to be a safe procedure to lower the mortality on the waiting list.
authors.affiliation: Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. sabine.daebritz@med.uni-muenchen.de
authors.forename: Sabine H
authors.initials: SH
authors.lastname: Daebritz
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: Helmut
authors.initials: H
authors.lastname: Mair
authors.forename: Rainer
authors.initials: R
authors.lastname: Kozlik-Feldmann
authors.forename: Georg
authors.initials: G
authors.lastname: Wittmann
authors.forename: Christian
authors.initials: C
authors.lastname: Kowalski
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility; D001788:Blood Grouping and Crossmatching / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006388:Hemagglutinins / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D006388:Hemagglutinins; D007166:Immunosuppressive Agents