Equivalent Outcomes for Pediatric Heart Transplantation Recipients: ABO‐Blood Group Incompatible versus ABO‐Compatible

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...

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Bibliographic Details
Published in:American journal of transplantation 2010-02, Vol.10 (2), p.389-397
Main Authors: Dipchand, A. I., Pollock BarZiv, S. M., Manlhiot, C., West, L. J., VanderVliet, M., McCrindle, B. W.
Format: Article
Language:English
Subjects:
ABO Blood-Group System - immunology
ABO incompatibility
Antibodies - immunology
Antineoplastic Combined Chemotherapy Protocols
Biological and medical sciences
Bleomycin
Blood Group Antigens - immunology
Child
General aspects
Graft Rejection - immunology
heart transplantation
Heart Transplantation - immunology
Heart Transplantation - mortality
Hemagglutinins - immunology
Humans
Infant
Medical sciences
Methotrexate
pediatric transplantation
Pediatrics
rejection
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tissue Donors - statistics & numerical data
Treatment Outcome
Vincristine
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Summary: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. Comparison of two contemporary pediatric populations who received either ABO‐compatible or ABO‐incompatible heart transplants found that medium‐term outcomes were indistinguishable, and the use of ABO‐incompatible listing improved waitlist survival.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2009.02934.x