Heart transplantation with ABO blood type–incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.
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References
1.
BoucekMMMathisCMRazzoukA. Indications and contraindications for heart transplantation in infancy. J Heart Lung Transplant.1993;12:S154–S158.
2.
MorrowWRNaftelDChinnockR. Outcome of listing for heart transplantation in infants younger than six months: Predictors of death and interval to transplantation. J Heart Lung Transplant.1997;16:1255–1266.
3.
BoucekM. Breaching the barrier of ABO-incompatibility in heart transplantation for infants. N Engl J Med.2001;344:843–844.
4.
DellgrenGKoiralaBSakopoulusA. Surgery for congenital heart disease. Pediatric heart transplantation: Improving results in high-risk patients. J Thorac Cardiovasc Surg.2001;121:782–791.
5.
American Association of Blood Banks. ABO, H, and Lewis blood groups and structurally related antigens. In: Technical Manual.13th ed.Bethesda, Md: American Association of Blood Banks; 1999:274–277.
AlbrechtsenDGeiranOFoersterA. Cardiac transplantation from a blood group ABO-incompatible donor: A case report. Transplant Proc.1990;22:782–791.
8.
CooperDKC. Clinical survey of heart transplantation between ABO blood group-incompatible recipients and donors. Int Soc Heart Transplant.1990;9:376–381.
9.
CooperDKC. A clinical survey of cardiac transplantation between ABO blood group-incompatible recipients and donors. Transplant Proc.1990;22:1457.
10.
StarzlTETzakisAMakowkaL. The definition of ABO factors in transplantation: Relation to other humoral antibody states. Transplant Proc.1987;29:4492–4497.
11.
PikulFJBolmanRMSaffitzJEChaplinH. Anti-B mediated rejection of an ABO-incompatible cardiac allograft despite aggressive plasma exchange transfusion. Transplant Proc.1987;29:4601–4604.
12.
StiehmER. Ontogeny of immunity. In: StiehmEROchsHDWinkelsteinJA, eds. Immunologic Disorders in Infants and Children.5th ed.Philadelphia, Pa: WB Saunders; 2004:3–19.
13.
AndersonKCNessPM. Alloimmunization in neonates. In: AndersonKC, ed. Scientific Basis of Transfusion Medicine: Implications for Clinical Practice.Philadelphia, Pa: WB Saunders; 2000:337–345.
ViganoAEspositoSArientiD. Differential development of type 1 and type 2 cytokines and B-chemokines in the ontogeny of healthy newborns. Biol Neonate.1999;75:1–8.
16.
CarrollWLAddersonEEQuinnAShackelfordPG. Immunoglobulin variable region gene expression in response to Haemophilus influenzae type b polysaccharide. J Infect Dis.1992;165(suppl 1):57–61.
17.
AddersonEEChisholmNHalperinSA. Immunization with Haemophilus influenzae type b polysaccharide vaccine at 18 and 24 months of age: Evidence of decreased immunogenicity. Clin Investigative Med.1991;14:338–345.
18.
LudvigsenCWSwansonJLThompsonTRMcCulloughJ. The failure of neonates to form red blood cell alloantibodies in response to multiple transfusions. Am J Clin Pathol.1987;87:250–251.
19.
FlossAMStraussRGGoekenNKnoxL. Multiple transfusions fail to provoke antibodies against blood cell antigens in human infants. Transfusion.1986;26:419–422.
20.
MaurCAHodelMNydeggerUERiebenR. Age dependency of ABO histo-blood group antibodies: Reexamination of an old dogma. Transfusion.1993;33:915–918.
21.
FongSWQaqundahBYTaylorWF. Developmental patterns of ABO isoagglutinins in normal children correlated with the effects of age, sex and maternal isoagglutinins. Transfusion.1974;14:6:551–559.
22.
WestLPhilDPollock-BarzivSM. ABO-incompatible heart transplantation in infants. N Engl J Med.2001;44:793–800.
23.
American Association of Blood Banks. ABO, Lewis, Ii and P groups. In: Technical Manual.13th ed.Bethesda, Md: American Association of Blood Banks; 1999:161.
24.
RoseAGCooperDKCHumanPA. Histopathology of hyperacute rejection of the heart: Experimental and clinical observations in allografts and xenografts. J Heart Lung Transplant.1991;10:223–234.
25.
MacDonaldAS. A Guide to the Clinical Use of Tacrolimus for Transplant Professionals.2nd ed.Ontario, Canada: Fujisawa, Canada, Inc: 2001.
26.
SaitoKNakagawaYTanikawaT. Efficacy of tacrolimus in ABO-incompatible kidney transplantation: Clinicopathological aspects of humoral rejection. Transplant Proc.1999;31:2851–2852.
27.
RoseMLSmithJDureauG. Mycophenolate mofetil decreases antibody production after cardiac transplantation. J Heart Lung Transplant.2002;21:282–285.
28.
MohacsiPRiebenRNydeggerUE. Immunosuppression in ABO-incompatible transplantation. Transplant Proc.2001;33:2223–2224.
