title: ABO-incompatible heart transplants.
abstract: A month-old baby girl with blood type O positive received a donor heart organ from a donor with blood type B. This was the first institutional ABO-incompatible heart transplant. Infants listed for transplantation may be considered for an ABO-incompatible heart transplant based on their antibody levels and age. The United Network of Organ Sharing (UNOS) protocol is infants under 24 months with titers less than or equal to 1:4.(1) This recipient's anti-A and anti-B antibodies were monitored with titer assays to determine their levels; antibody levels less than 1:4 are acceptable pre-transplant in order to proceed with donor and transplant arrangements.1 Immediately prior to initiating cardiopulmonary bypass (CPB), a complete whole body exchange transfusion of at least two-times the patient's circulating blood volume was performed with packed red blood cells (pRBC), fresh frozen plasma (FFP) and 25% albumin. Titer assays were sent two minutes after initiation of full CPB and then hourly until the cross-clamp was removed. Institutionally, reperfusion of the donor heart is not restored until the antibody level from the titer assay is known and reported as less than 1:4; failing to achieve an immulogically tolerant recipient will provide conditions for hyperacute rejection. The blood collected during the transfusion exchange was immediately processed through a cell saver so the pRBC's could be re-infused to the patient during CPB, as necessary. The remainder of the transplant was performed in the same fashion as an ABO-compatible heart transplant. The patient has shown no signs of rejection following transplantation.
authors.affiliation: Vanderbilt University Medical Center Cardiovascular Perfusion Technology Program, Nashville, Tennessee, USA molly.hageman@vanderbilt.edu.
authors.forename: M
authors.initials: M
authors.lastname: Hageman
authors.affiliation: Vanderbilt University Medical Center Cardiovascular Perfusion Technology Program, Nashville, Tennessee, USA.
authors.forename: N
authors.initials: N
authors.lastname: Michaud
authors.affiliation: Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
authors.forename: I
authors.initials: I
authors.lastname: Chinnappan
authors.affiliation: Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
authors.forename: T
authors.initials: T
authors.lastname: Klein
authors.affiliation: Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
authors.forename: B
authors.initials: B
authors.lastname: Mettler
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility / Q000628:therapy*; D002315:Cardiopulmonary Bypass; D017707:Erythrocyte Transfusion; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007518:Isoantibodies / Q000097:blood; D010949:Plasma
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies
keywords: ABO-incompatible; heart; pediatric; perfusion; transplantation