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Dual immunoadsorption for ABO-incompatible heart transplantation in a 35 kg child
Richard Crook1, Marc Cohen2, Branko Mimic3
1Department of Perfusion, Great Ormond Street Hospital for Children, London, UK.
Perfusion
|August 1, 2024
Summary
Intraoperative anti-A/B immunoadsorption (ABO-IA) enabled ABO-incompatible heart transplants in a patient requiring two parallel ABO-IA columns. This innovative approach successfully lowered antibody titers for organ implantation.
Area of Science:
- Cardiology
- Immunology
- Transplantation
Background:
- ABO-incompatible (ABOi) heart transplantation presents challenges due to pre-formed anti-A/B antibodies.
- Intraoperative anti-A/B immunoadsorption (ABO-IA) is a novel strategy to mitigate antibody levels during surgery.
Purpose of the Study:
- To report the first case of ABO-incompatible heart transplantation utilizing intraoperative ABO-IA in a patient with specific age and weight considerations.
- To demonstrate the efficacy of a dual-column parallel ABO-IA system for rapid antibody titer reduction.
Main Methods:
- The patient underwent ABO-incompatible heart transplantation.
- Two ABO-IA columns were operated in parallel during the intraoperative period.
- Antibody titers were monitored to assess the effectiveness of the immunoadsorption procedure.
Main Results:
- The dual-column parallel ABO-IA system effectively reduced antibody titers to a level suitable for organ implantation.
- Successful ABO-incompatible heart transplantation was achieved in this complex patient case.
Conclusions:
- Intraoperative ABO-IA, particularly with a dual-column setup, is a viable strategy for ABO-incompatible heart transplantation in patients requiring significant antibody reduction.
- This case highlights the adaptability of ABO-IA for challenging patient profiles in heart transplantation.
