Successful ABO incompatible heart transplantation after desensitization therapy in an older child

Author:

Krauss Annemarie1ORCID,West Lori J.23ORCID,Conway Jennifer4ORCID,Khoury Michael4ORCID,Nahirniak Susann5ORCID,Halpin Anne5ORCID,Al Aklabi Mohammed6,Urschel Simon4ORCID

Affiliation:

1. Division of Pediatric Cardiology at the University of Alberta Deutsches Herzzentrum Berlin Germany

2. Departments of Pediatrics, Surgery, Medical Microbiology/Immunology and Laboratory Medicine/Pathology, University of Alberta Alberta Transplant Institute Edmonton Alberta Canada

3. Canadian Donation and Transplantation Research Program Edmonton Alberta Canada

4. Division of Pediatric Cardiology at the University of Alberta Edmonton Alberta Canada

5. Department of Laboratory Medicine and Pathology University of Alberta and Alberta Precision Laboratories Edmonton Alberta Canada

6. Division of Pediatric Cardiac Surgery Stollery Children's Hospital Edmonton Alberta Canada

Abstract

AbstractBackgroundABO‐incompatible heart transplantation (HTx) has become a standard procedure for children below 2 years of age due to an immunologically immature immune system and associated low isohemagglutinin titers.MethodsWe report a case of an ABO‐incompatible HTx (recipient blood group O, donor blood group A) at the age of 5 years and 11 months with a fully matured immune system and previously high isohemagglutinin titers that diminished as a result of human leucocyte antigen (HLA) desensitization therapy with rituximab and immunoglobulins.ResultsThe anti‐A titer at the time of HTx was 1:16 with post‐transplant isoagglutinin titers never exceeding 1:4 without any signs of rejection with now 3 years of post‐HTx follow‐up.ConclusionsABO isohemagglutinin titers should be routinely assessed in children undergoing desensitization therapy since ABOi transplantation can be considered in selected cases to expand the donor pool with the option of crossing the ABO barrier to find a better‐matched allograft.

Publisher

Wiley

Subject

Transplantation,Pediatrics, Perinatology and Child Health

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