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Eur J Cardiothorac Surg 2007;31:339-343. doi:10.1016/j.ejcts.2006.11.032
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Blood type incompatible cardiac transplantation in young infants

^a Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
^b Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
^c Department of Transfusion Medicine, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
^d Department of Anesthesiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany

Received 14 June 2006; received in revised form 22 November 2006; accepted 24 November 2006.

^_* Corresponding author. Address: Cardiac Surgery, University Hospital Grosshadern, D-81377 Munich, Germany. Tel. +49 89 7095 3946; fax: +49 89 7095 8873. (Email: sabine.daebritz{at}med.uni-muenchen.de).

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.

Key Words: Pediatric heart transplantation • ABO-incompatible • Congenital heart surgery • Heart transplantation