Lori J. West, M.D., D.Phil., Stacey M. Pollock-Barziv, M.A., Anne I. Dipchand, M.D., K. Jin Lee, M.D., Carl J. Cardella, M.D., Leland N. Benson, M.D., Ivan M. Rebeyka, M.D., and John G. Coles, M.D.
Background Transplantation of hearts from ABO-incompatible donorsis contraindicated because of the risk of hyperacute rejectionmediated by preformed antibodies in the recipient to blood-groupantigens of the donor. This contraindication may not apply tonewborn infants, who do not yet produce antibodies to T-cell–independentantigens, including the major blood-group antigens.
Methods We studied 10 infants, 4 hours to 14 months old (median,2 months), who had congenital heart disease or cardiomyopathyand who received heart transplants from donors of incompatibleblood type between 1996 and 2000. Serum isohemagglutinin titerswere measured before and after transplantation. Plasma exchangewas performed during cardiopulmonary bypass; no other proceduresfor the removal of antibodies were used. Standard immunosuppressivetherapy was given, and rejection was monitored by means of endomyocardialbiopsy. The results were compared with those in 10 infants whoreceived heart transplants from ABO-compatible donors.
Results The overall survival rate among the 10 recipients withABO-incompatible donors was 80 percent, with 2 early deathsdue to causes presumed to be unrelated to ABO incompatibility.The duration of follow-up ranged from 11 months to 4.6 years.Two infants had serum antibodies to antigens of the donor'sblood group before transplantation. No hyperacute rejectionoccurred; mild humoral rejection was noted at autopsy in oneof the infants with antibodies. No morbidity attributable toABO incompatibility has been observed. Despite the eventualdevelopment of antibodies to antigens of the donor's blood groupin two infants, no damage to the graft has occurred. Becauseof the use of ABO-incompatible donors, the mortality rate amonginfants on the waiting list declined from 58 percent to 7 percent.
Conclusions ABO-incompatible heart transplantation can be performedsafely during infancy before the onset of isohemagglutinin production;this technique thus contributes to a marked reduction in mortalityamong infants on the waiting list.
Source Information
From the Division of Cardiology, Department of Paediatrics (L.J.W., S.M.P.-B., A.I.D., K.J.L., L.N.B.) and the Division of Cardiovascular Surgery, Department of Surgery (J.G.C.), Hospital for Sick Children and University of Toronto, Toronto; the Division of Nephrology, Department of Medicine, Toronto General Hospital and University of Toronto, Toronto (C.J.C.); and the Department of Surgery, University of Alberta Hospitals, Edmonton, Canada (I.M.R.).
Address reprint requests to Dr. West at the Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada, or at lwest{at}sickkids.on.ca.
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