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.
Hsu, D. T., Pearson, G. D.
(2009). Heart Failure in Children: Part II: Diagnosis, Treatment, and Future Directions. Circ Heart Fail
2: 490-498
[Full Text]
Almond, C. S.D., Thiagarajan, R. R., Piercey, G. E., Gauvreau, K., Blume, E. D., Bastardi, H. J., Fynn-Thompson, F., Singh, T.P.
(2009). Waiting List Mortality Among Children Listed for Heart Transplantation in the United States. Circulation
119: 717-727
[Abstract][Full Text]
Feingold, B., Wearden, P. D., Morell, V. O., Galvis, D., Galambos, C.
(2009). Expression of A and B Blood Group Antigens on Cryopreserved Homografts. Ann. Thorac. Surg.
87: 211-214
[Abstract][Full Text]
Alic, Y., Akpek, E. A., Donmez, A., Ozkan, S., Perfusionist, G. Y., Aslamaci, S.
(2008). ABO-Incompatible Blood Transfusion and Invasive Therapeutic Approaches During Pediatric Cardiopulmonary Bypass. Anesth. Analg.
107: 1185-1187
[Abstract][Full Text]
Hunt, S. A., Haddad, F.
(2008). The Changing Face of Heart Transplantation. J Am Coll Cardiol
52: 587-598
[Abstract][Full Text]
Griffith, B. P., Haddad, M., Poston, R. S.
(2008). Immunobiology of Heart and Heart-Lung Transplantation. Card Surg Adult
3: 1513-1538
[Full Text]
Irei, T., Ohdan, H., Zhou, W., Ishiyama, K., Tanaka, Y., Ide, K., Asahara, T.
(2007). The persistent elimination of B cells responding to blood group A carbohydrates by synthetic group A carbohydrates and B-1 cell differentiation blockade: novel concept in preventing antibody-mediated rejection in ABO-incompatible transplantation. Blood
110: 4567-4575
[Abstract][Full Text]
Pollock-BarZiv, S. M., den Hollander, N., Ngan, B.-Y., Kantor, P., McCrindle, B., West, L. J., Dipchand, A. I.
(2007). Pediatric Heart Transplantation in Human Leukocyte Antigen-Sensitized Patients: Evolving Management and Assessment of Intermediate-Term Outcomes in a High-Risk Population. Circulation
116: I-172-I-178
[Abstract][Full Text]
Daebritz, S. H., Schmoeckel, M., Mair, H., Kozlik-Feldmann, R., Wittmann, G., Kowalski, C., Kaczmarek, I., Reichart, B.
(2007). Blood type incompatible cardiac transplantation in young infants. Eur. J. Cardiothorac. Surg.
31: 339-343
[Abstract][Full Text]
Alsoufi, B., Bennetts, J., Verma, S., Caldarone, C. A.
(2007). New Developments in the Treatment of Hypoplastic Left Heart Syndrome. Pediatrics
119: 109-117
[Abstract][Full Text]
Guleserian, K. J., Armsby, L. B., Thiagarajan, R. R., del Nido, P. J., Mayer, J. E. Jr
(2006). Natural History of Pulmonary Atresia With Intact Ventricular Septum and Right-Ventricle-Dependent Coronary Circulation Managed by the Single-Ventricle Approach. Ann. Thorac. Surg.
81: 2250-2258
[Abstract][Full Text]
Rosenthal, D., Bernstein, D.
(2006). Pediatric Mechanical Circulatory Support: Challenges and Opportunities. Circulation
113: 2266-2268
[Full Text]
Botha, P., Hasan, A., Haynes, S., Cassidy, J., Roe, J., Wallis, J., Smith, J.
(2006). Exchange Transfusion During Extra Corporeal Membrane Oxygenation Used as a Bridge to ABO-Mismatch Cardiac Transplantation. Ann. Thorac. Surg.
81: 1105-1107
[Abstract][Full Text]
West, L. J., Karamlou, T., Dipchand, A. I., Pollock-BarZiv, S. M., Coles, J. G., McCrindle, B. W.
(2006). Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. J. Thorac. Cardiovasc. Surg.
131: 455-461
[Abstract][Full Text]
Ogle, B. M., West, L. J., Driscoll, D. J., Strome, S. E., Razonable, R. R., Paya, C. V., Cascalho, M., Platt, J. L.
(2006). Effacing of the T Cell Compartment by Cardiac Transplantation in Infancy. J. Immunol.
176: 1962-1967
[Abstract][Full Text]
Chaudhari, M., Sturman, J., O'Sullivan, J., Smith, J., Wrightson, N., Parry, G., Bolton, D., Haynes, S., Hamilton, L., Hasan, A.
(2005). Rescue cardiac transplantation for early failure of the Fontan-type circulation in children. J. Thorac. Cardiovasc. Surg.
129: 416-422
[Abstract][Full Text]
Jacobs, J. P., Quintessenza, J. A., Boucek, R. J., Morell, V. O., Botero, L. M., Badhwar, V., van Gelder, H. M., Asante-Korang, A., McCormack, J., Daicoff, G. R.
(2004). Pediatric Cardiac Transplantation in Children With High Panel Reactive Antibody. Ann. Thorac. Surg.
78: 1703-1709
[Abstract][Full Text]
Burch, M, Aurora, P
(2004). Current status of paediatric heart, lung, and heart-lung transplantation. Arch. Dis. Child.
89: 386-389
[Abstract][Full Text]
Poston, R. S., Griffith, B. P.
(2004). Heart Transplantation. J Intensive Care Med
19: 3-12
[Abstract]
Foreman, C, Gruenwald, C, West, L
(2004). ABO-incompatible heart transplantation: a perfusion strategy. Perfusion
19: 69-72
[Abstract]
McMahon, A.-M., van Doorn, C., Burch, M., Whitmore, P., Neligan, S., Rees, P., Radley-Smith, R., Goldman, A., Brown, K., Cohen, G., Tsang, V., Elliott, M., de Leval, M. R.
(2004). Improved early outcome for end-stage dilated cardiomyopathy in children. J. Thorac. Cardiovasc. Surg.
126: 1781-1787
[Abstract][Full Text]
Ogle, B. M., Cascalho, M., Joao, C., Taylor, W., West, L. J., Platt, J. L.
(2003). Direct measurement of lymphocyte receptor diversity. Nucleic Acids Res
31: e139-e139
[Abstract][Full Text]
Eltzschig, H. K., Ehlers, R., Shernan, S. K., Rodriguez, W., Silver, S. M., Schoevaerdts, D., Swine, C., Vanpee, D., Jessup, M., Brozena, S.
(2003). Heart Failure. NEJM
349: 1002-1004
[Full Text]
Griffith, B. P., Poston, R. S.
(2003). Immunobiology of Heart and Heart-Lung Transplantation. Card Surg Adult
2: 1403-1426
[Full Text]
Azeka, E., Franchini Ramires, J. A., Valler, C., Alcides Bocchi, E.
(2002). Delisting of infants and children from the heart transplantation waiting list after carvedilol treatment. J Am Coll Cardiol
40: 2034-2038
[Abstract][Full Text]
West, L J
(2002). Defining critical windows in the development of the human immune system. Hum Exp Toxicol
21: 499-505
[Abstract]
HAMILTON, J R L., HASAN, A.
(2001). Cardiopulmonary transplantation in children: a reason for optimism?. Heart
86: 607-608
[Full Text]
Previous
