Single center experience with ABO-incompatible and ABO-compatible pediatric heart transplantation

Area of Science:

• Cardiology
• Pediatric Surgery
• Immunology

Background:

• Pediatric heart transplantation (pHTx) is a critical treatment for end-stage heart failure in children.
• ABO-incompatible (ABOi) transplantation presents unique immunological challenges.
• Comparing outcomes of ABOi-HTx versus ABO-compatible (ABOc) HTx is essential for optimizing patient care.

Purpose of the Study:

• To analyze and compare the outcomes of pediatric heart transplantation (pHTx) differentiating between ABO-incompatible (ABOi) and ABO-compatible (ABOc) procedures at a single center.
• To evaluate the safety and efficacy of ABOi-HTx in a pediatric population.
• To assess the impact of ABOi-HTx on waiting times and post-transplant survival.

Main Methods:

• Retrospective analysis of pediatric heart transplantation (pHTx) cases performed between 2003 and 2015.
• Comparison of outcomes between 7 ABO-incompatible (ABOi) and 11 ABO-compatible (ABOc) pediatric heart transplant recipients.
• Evaluation of pre-transplant support, waiting times, rejection rates, and graft survival.

Main Results:

• The mean waiting time for ABO-incompatible (ABOi) pediatric heart transplantation (pHTx) was significantly shorter (36 days) compared to ABO-compatible (ABOc) pHTx (86 days).
• Five-year re-transplant-free survival was high for both groups (86% for ABOi-HTx, 91% for ABOc-HTx).
• Acute cellular rejection occurred in 2/7 ABOi-HTx patients versus 9/11 ABOc-HTx patients; early graft failure was not observed in the ABOi-HTx group.

Conclusions:

• Pediatric heart transplantation (pHTx) in ABO-incompatible (ABOi) settings is a safe and viable option, offering reduced waiting times.
• ABOi-HTx strategies should be further developed to potentially increase timely access to transplantation and mitigate waiting list complications.
• The findings support the expansion of ABOi-HTx protocols to improve outcomes for pediatric heart recipients.