Equivalent outcomes for pediatric heart transplantation recipients: ABO-blood group incompatible versus ABO-compatible

A. I. Dipchand, S. M. Pollock Barziv, C. Manlhiot, L. J. West, M. Vandervliet, B. W. McCrindle

Research output: Contribution to journalArticle

Abstract

ABO-blood group incompatible infant heart transplantation has had excellent short-term outcomes. Uncertainties about long-term outcomes have been a barrier to the adoption of this strategy worldwide. We report a nonrandomized comparison of clinical outcomes over 10 years of the largest cohort of ABO-incompatible recipients. ABO-incompatible (n = 35) and ABO-compatible (n = 45) infant heart transplantation recipients (≤14 months old, 1996-2006) showed no important differences in pretransplantation characteristics. There was no difference in incidence of and time to moderate acute cellular rejection. Despite either the presence (seven patients) or development (eight patients) of donor-specific antibodies against blood group antigens, in only two ABO-incompatible patients were these antibodies implicated in antibody-mediated rejection (which occurred early posttransplantation, was easily managed and did not recur in follow-up). Occurrence of graft vasculopathy (11%), malignancy (11%) and freedom from severe renal dysfunction were identical in both groups. Survival was identical (74% at 7 years posttransplantation). ABO-blood group incompatible heart transplantation has excellent outcomes that are indistinguishable from those of the ABO-compatible population and there is no clinical justification for withholding this lifesaving strategy from all infants listed for heart transplantation. Further studies into observed differing responses in the development of donor-specific isohemagglutinins and the implications for graft accommodation are warranted.

Original languageEnglish (US)
Pages (from-to)389-397
Number of pages9
JournalAmerican Journal of Transplantation
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2010
Externally publishedYes

Keywords

  • ABO incompatibility
  • Heart transplantation
  • Pediatric transplantation
  • Rejection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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