Related Experiment Video
Updated: Jul 17, 2026
Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique
Published on: October 12, 2014
Blood type incompatible cardiac transplantation in young infants
Sabine H Daebritz1, Michael Schmoeckel, Helmut Mair
1Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. sabine.daebritz@med.uni-muenchen.de
Insights
ABO-incompatible heart transplants in infants offer a promising solution to donor organ shortages. This approach demonstrates safe and effective short-term outcomes, potentially reducing waiting list mortality.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Immunosuppression Therapy
Background:
- Donor organ shortage significantly impacts pediatric heart transplantation (HTx) outcomes, with mortality rates on the waiting list ranging from 30-50%.
- Infants possess immature immune systems, presenting an opportunity for ABO-incompatible HTx to expand donor availability.
Observation:
- Three infants (ages 3.5-7 months) with complex heart conditions underwent ABO-incompatible HTx, receiving organs from donors with blood types A or B, while recipients were blood type O.
- Preoperative isohemagglutinin titers were low. Intraoperative plasma exchange removed antibodies, followed by immunosuppression including ATG, tacrolimus, mycophenolate mofetil, and prednisone.
Findings:
- All three patients exhibited excellent ventricular function post-transplant with no acute rejection episodes during follow-up periods of 12-17 months.
- Extubation occurred rapidly (days 1-15), and isohemagglutinin titers against donor blood types diminished post-procedure.
- One patient remains on dialysis, indicating potential long-term challenges.
Implications:
- ABO-incompatible cardiac transplantation in young infants yields favorable short-term results.
- This strategy appears to be a safe and viable option for increasing donor organ availability and reducing mortality in pediatric heart transplantation waiting lists.
Objective:
Donor organ shortage in pediatric heart transplantation (HTx) is causing mortality rates of 30-50% on the waiting list. Due to immaturity of the immune system of newborns and infants, ABO-incompatible HTx may be an option to increase donor availability. We present our experience with ABO-incompatible HTx.
Methods:
Three infants were transplanted ABO-incompatible since 12/2004: (1) hypoplastic left heart complex, (2) restrictive hypertrophic cardiomyopathy, (3) dilative cardiomyopathy. Age at HTx was 7, 5, and 3.5 months. All recipients had blood type O, donors were A, A, and B. Informed consent was given by parents, the ethics committee, and Eurotransplant.
Results:
Preoperative isohemagglutinin titers were low (Patient 1: 1:4 for anti-A1, A2, B, Patient 2: 1:4, 1:1, 1:4 for anti-A1, A2, B, respectively, and Patient 3: 0 for all, but quick spin 1+ for all). Intraoperatively, plasma was separated from red blood cells and discarded up to six times until antibodies were eliminated. Immunosuppressive induction with ATG was started for 5 days. Basic immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisone. Extubation was performed on days 15, 2, and 1, respectively. After a follow-up of 17, 16, and 12 months all patients are well, ventricular function is excellent without any acute rejection periods; Patient 1 is still on dialysis. Isohemagglutinin titers against donor blood type have disappeared in follow-up.
Conclusions:
ABO-incompatible cardiac transplantation shows good short-term results in young infants and seems to be a safe procedure to lower the mortality on the waiting list.
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