Successful ABO-incompatible heart transplantation in a child despite blood-group sensitization after ventricular assist device support.
In the first two yr of life blood-group incompatible (ABO-incompatible) heart transplantation can be performed leading to immune tolerance to donor blood group. Antibody titers should be below 1:4. VAD use is correlated with sensitization toward blood-group antigens. A boy was diagnosed with dilated cardiomyopathy at nine months of age and listed for 0-compatible transplantation. Progressive heart failure required implantation of a left VAD. His listing was extended for ABO-incompatible transplantation despite antibody titers of 1:32 anti-A and 1:8 anti-B. After 26 days on VAD, he was transplanted with a B donor heart. No hyperacute or acute rejection occurred in 12 months post-transplant. Anti-B antibodies rose to a maximum of 1:2. No use of rituximab or plasmapheresis was required. There are no signs of graft vasculopathy. This indicates that inclusion criteria for ABO-incompatible transplantation may be extended to immediate cases. This is the first case with a healthy immune system to show signs of tolerance development after ABO-incompatible heart transplantation with increased prior antibody titers and without specific treatment.
Urschel
S
S
Pediatric Cardiology and Intensive Care, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany. simon.urschel@med.uni-muenchen.de
Dalla Pozza
R
R
Loeff
M
M
Schmitz
C
C
Sodian
R
R
Schmoeckel
M
M
Kowalski
C
C
Netz
H
H
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology; D006084:Graft Rejection; D006333:Heart Failure / Q000628:therapy; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D007107:Immune System; D007223:Infant; D008297:Male; D013997:Time Factors; D023001:Transplantation Tolerance; D016896:Treatment Outcome
D000017:ABO Blood-Group System