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Successful ABO‐incompatible heart transplantation in a child despite blood‐group sensitization after ventricular assist device support
Author(s) -
Urschel S.,
Dalla Pozza R.,
Loeff M.,
Schmitz C.,
Sodian R.,
Schmoeckel M.,
Kowalski C.,
Netz H.
Publication year - 2009
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2008.01030.x
Subject(s) - medicine , plasmapheresis , abo blood group system , transplantation , heart transplantation , rituximab , antibody titer , blood type (non human) , ventricular assist device , cardiology , antibody , immunology , surgery , heart failure , titer
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.