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Related Experiment Video

Updated: Mar 1, 2026

Blood Circuit Reconstruction in an Abdominal Mouse Heart Transplantation Model
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Blood Circuit Reconstruction in an Abdominal Mouse Heart Transplantation Model

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A novel method for ABO-incompatible heart transplantation.

Alex Robertson1, Richard Issitt1, Richard Crook1

  • 1Department of Perfusion, Great Ormond Street Hospital, London.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|May 31, 2017
PubMed
Summary

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Anti-A/B immunoadsorption effectively removes isohemagglutinins during cardiopulmonary bypass (CPB), making ABO-incompatible heart transplants safer and more accessible. This method reduces blood product needs and expands eligibility for more patients.

Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Transplantation Medicine

Background:

  • ABO-incompatible heart transplantation traditionally uses plasma exchange on cardiopulmonary bypass (CPB) to remove isohemagglutinins.
  • This method requires significant blood products and can cause hemodynamic instability, limiting its use.
  • Current methods are primarily suitable for small pediatric recipients.

Purpose of the Study:

  • To evaluate the efficacy of anti-A/B immunoadsorption within the CPB circuit for removing isohemagglutinins.
  • To assess the potential of this technique for clinical application in ABO-incompatible heart transplantation.

Main Methods:

  • An anti-A/B immunoadsorption column was integrated into a CPB circuit primed with type O blood.
  • Plasma samples were collected after each pass through the immunoadsorption column to measure isohemagglutinin titers.
Keywords:
ABO mismatch transplantationcardiopulmonary bypassheart transplantationimmunoadsorptionisohemagglutininpaediatric

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  • The study was conducted in an ex vivo setting to simulate clinical conditions.

    • Main Results:

    • A consistent, linear reduction of at least one dilution in anti-A and anti-B IgG and IgM antibodies was observed with each plasma volume pass.
    • The predictable antibody removal enabled the development of selection criteria for ABO-incompatible heart transplantation based on titer and patient weight.
    • This technique successfully reduced antibody levels to undetectable levels in clinical applications.

    Conclusions:

    • Integrating anti-A/B immunoadsorption into the extracorporeal circuit significantly reduces the need for allogeneic blood products in ABO-incompatible heart transplantation.
    • The method provides effective removal of anti-A and anti-B isohemagglutinins within the CPB time frame before graft reperfusion.
    • This approach expands the recipient pool by accommodating larger patients and those with higher isohemagglutinin titers.