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Updated: Jun 9, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Single center experience with ABO-incompatible and ABO-compatible pediatric heart transplantation
L Lily Rosenthal1,2, Tabea Katharina Spickermann1,3, Sarah Marie Ulrich4,5
1Department of Heart Surgery/Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilian University Munich, Munich, Germany.
Insights
Pediatric heart transplantation (pHTx) that is ABO-incompatible (ABOi) is safe and effective, leading to shorter waiting times compared to ABO-compatible (ABOc) procedures. Further development of ABOi-HTx strategies could improve timely transplantation and prevent complications.
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.
Introduction:
The aim of this study was to analyze the results after pediatric heart transplantation (pHTx) at our single center differentiating between ABO-incompatible (ABOi) and -compatible (ABOc) procedures.
Methods And Patients:
We retrospectively analyzed outcomes of ABO-incompatible HTx procedures performed at our center and compared the data to ABO-compatible HTx of the same era. Eighteen children (<17 months) underwent pediatric HTx and seven of them underwent ABO-incompatible HTx between 2003 and 2015.
Results:
Mechanical circulatory support as bridge to transplant was necessary in 3/7 patients before ABO-incompatible HTx and in 3/11 patients before ABO-compatible HTx. Mean waiting time on the list was 36 ± 30 days for ABO-incompatible HTx and 86 ± 65 days for ABO-compatible HTx. The 5-years re-transplant free survival was 86% following ABO-incompatible and 91% after ABO-compatible. In the cohort undergoing ABO-incompatible HTx, 2 patients showed an acute cellular rejection, while early graft failure was not observed. In the cohort undergoing ABOcompatible HTx, acute cellular rejection was observed in 9/11 patients, with early graft failure occurring in nine and CVP in two. A total of ten children were listed for ABO-incompatible HTx after 2015; however, all ten underwent an ABO-compatible transplantation.
Discussion:
This study adds much needed information to the literature on ABOi-HTx by showing with a retrospective single center analysis that it is safe and leads to shorter waiting times. We conclude that strategies for ABOi-HTx should be elaborated further, potentially allowing more timely transplantation and thereby preventing waiting list complications such as the need for mechanical circulatory support and even death.
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