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ABO-incompatible heart transplantation in infants
L J West1, S M Pollock-Barziv, A I Dipchand
1Department of Paediatrics, Hospital for Sick Children and University of Toronto, ON, Canada. lwest@sickkids.on.ca
The New England Journal of Medicine
|March 15, 2001
Summary
ABO-incompatible heart transplants in infants are safe and effective, significantly reducing waiting list mortality. This approach avoids hyperacute rejection in newborns before antibody development.
Area of Science:
- Pediatric Cardiology
- Transplant Immunology
- Organ Transplantation
Background:
- ABO-incompatible donor hearts traditionally risk hyperacute rejection due to preformed antibodies.
- Newborn infants may not produce antibodies to major blood group antigens, potentially altering this risk.
Purpose of the Study:
- To evaluate the safety and efficacy of ABO-incompatible heart transplantation in infants.
- To assess the impact of this strategy on reducing infant heart transplant waiting list mortality.
Main Methods:
- Studied 10 infants (4 months–14 months) receiving ABO-incompatible heart transplants.
- Monitored isohemagglutinin titers, performed plasma exchange, and used standard immunosuppression.
- Compared outcomes with 10 infants receiving ABO-compatible transplants.
Main Results:
- 80% survival rate in ABO-incompatible recipients; no hyperacute rejection observed.
- Mild humoral rejection in one case; no graft damage despite antibody development.
- Waiting list mortality decreased from 58% to 7% due to ABO-incompatible transplants.
Conclusions:
- ABO-incompatible heart transplantation is safe in infants before isohemagglutinin production.
- This method significantly reduces mortality for infants awaiting heart transplants.