ABO-incompatible cardiac transplantation in pediatric patients with high isohemagglutinin titers.
J Heart Lung Transplant
; 34(8): 1095-102, 2015 Aug.
Article
en En
| MEDLINE
| ID: mdl-26116516
ABSTRACT
BACKGROUND:
ABO-incompatible (ABOi) cardiac transplantation is now used widely in infants with isohemagglutinin titers <14, but there is increasing evidence that ABOi transplantation can also be used in children with significantly higher titers. We reviewed our high-titer ABOi transplants and report our results here.METHODS:
Patients who underwent ABOi cardiac transplantation from 2000 to 2013 with pre-existing isohemagglutinin titers of ≥116 were identified from departmental databases. Outcomes were reviewed using medical and laboratory records.RESULTS:
Thirty patients underwent ABOi cardiac transplantation between 2000 and 2013. Twelve (40%) had pre-transplant isohemagglutinin titers of ≥116 and were included for further study. Median age was 14.9 (range 9.8 to 107.3) months and median weight was 9.6 (range 7.6 to 25) kg. Five (42%) were male. Pre-transplant diagnosis was cardiomyopathy in 8 of 12 (67%) and congenital heart disease in 4 of 12 (33%). Highest pre-transplant isohemagglutinin titer was 1256 in 2 patients. Four patients (33%) had early antibody-mediated rejection (AMR), all within 15 days post-transplant. Management included use of rituximab, bortezomib, immunoadsorption and eculizumab. Three patients died but no deaths were associated with high isohemagglutinin titers.CONCLUSIONS:
ABOi cardiac transplantation in patients with isohemagglutinin titers ≥116 is possible. AMR may occur early and immunoadsorption has proven effective at decreasing antibody titers.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Incompatibilidad de Grupos Sanguíneos
/
Sistema del Grupo Sanguíneo ABO
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Trasplante de Corazón
/
Insuficiencia Cardíaca
/
Hemaglutininas
Tipo de estudio:
Etiology_studies
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Child
/
Child, preschool
/
Female
/
Humans
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Infant
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Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Heart Lung Transplant
Asunto de la revista:
CARDIOLOGIA
/
TRANSPLANTE
Año:
2015
Tipo del documento:
Article