ABO-incompatible heart transplantation in infants.

被引:285
作者
West, LJ
Pollock-Barziv, SM
Dipchand, AI
Lee, KJ
Cardella, CJ
Benson, LN
Rebeyka, IM
Coles, JG
机构
[1] Hosp Sick Children, Dept Pediat, Div Cardiol, Toronto, ON M5G 1X8, Canada
[2] Hosp Sick Children, Dept Surg, Div Cardiovasc Surg, Toronto, ON M5G 1X8, Canada
[3] Univ Toronto, Toronto, ON, Canada
[4] Toronto Gen Hosp, Dept Med, Div Nephrol, Toronto, ON M5G 1L7, Canada
[5] Univ Alberta Hosp, Dept Surg, Edmonton, AB T6G 2B7, Canada
关键词
D O I
10.1056/NEJM200103153441102
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Transplantation of hearts from ABO-incompatible donors is contraindicated because of the risk of hyperacute rejection mediated by preformed antibodies in the recipient to blood-group antigens of the donor. This contraindication may not apply to newborn infants, who do not yet produce antibodies to T-cell-independent antigens, including the major blood-group antigens. Methods: We studied 10 infants, 4 hours to 14 months old (median, 2 months), who had congenital heart disease or cardiomyopathy and who received heart transplants from donors of incompatible blood type between 1996 and 2000. Serum isohemagglutinin titers were measured before and after transplantation. Plasma exchange was performed during cardiopulmonary bypass; no other procedures for the removal of antibodies were used. Standard immunosuppressive therapy was given, and rejection was monitored by means of endomyocardial biopsy. The results were compared with those in 10 infants who received heart transplants from ABO-compatible donors. Results: The overall survival rate among the 10 recipients with ABO-incompatible donors was 80 percent, with 2 early deaths due to causes presumed to be unrelated to ABO incompatibility. The duration of follow-up ranged from 11 months to 4.6 years. Two infants had serum antibodies to antigens of the donor's blood group before transplantation. No hyperacute rejection occurred; mild humoral rejection was noted at autopsy in one of the infants with antibodies. No morbidity attributable to ABO incompatibility has been observed. Despite the eventual development of antibodies to antigens of the donor's blood group in two infants, no damage to the graft has occurred. Because of the use of ABO-incompatible donors, the mortality rate among infants on the waiting list declined from 58 percent to 7 percent. Conclusions: ABO-incompatible heart transplantation can be performed safely during infancy before the onset of isohemagglutinin production; this technique thus contributes to a marked reduction in mortality among infants on the waiting list. (N Engl J Med 2001;344:793-800.) Copyright (C) 2001 Massachusetts Medical Society.
引用
收藏
页码:793 / 800
页数:8
相关论文
共 39 条
[1]   Conjugated polysaccharide vaccines [J].
Ahmad, H ;
Chapnick, EK .
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA, 1999, 13 (01) :113-+
[2]  
ALEXANDRE GPJ, 1987, TRANSPLANT P, V19, P4538
[3]   HYPERTROPHIC CARDIOMYOPATHY ASSOCIATED WITH TACROLIMUS IN PEDIATRIC TRANSPLANT PATIENTS [J].
ATKISON, P ;
JOUBERT, G ;
BARRON, A ;
GRANT, D ;
PARADIS, K ;
SEIDMAN, E ;
WALL, W ;
ROSENBERG, H ;
HOWARD, J ;
WILLIAMS, S ;
STILLER, C .
LANCET, 1995, 345 (8954) :894-896
[4]   Accommodation of vascularized xenografts: Expression of ''protective genes'' by donor endothelial cells in a host Th2 cytokine environment [J].
Bach, FH ;
Ferran, C ;
Hechenleitner, P ;
Mark, W ;
Koyamada, N ;
Miyatake, T ;
Winkler, H ;
Badrichani, A ;
Candinas, D ;
Hancock, WW .
NATURE MEDICINE, 1997, 3 (02) :196-204
[5]  
BAILEY LL, 1993, J THORAC CARDIOV SUR, V105, P805
[6]  
BANNETT AD, 1987, TRANSPLANTATION, V43, P909
[7]   Mycophenolate mofetil [J].
Becker, BN .
TRANSPLANTATION PROCEEDINGS, 1999, 31 (07) :2777-2778
[8]  
Billingham M E, 1990, J Heart Transplant, V9, P587
[9]   The registry of the International Society of Heart and Lung Transplantation: Third Official Pediatric Report - 1999 [J].
Boucek, MM ;
Faro, A ;
Novick, RJ ;
Bennett, LE ;
Fiol, B ;
Keck, BM ;
Hosenpud, JD .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 1999, 18 (12) :1151-1172
[10]   Potential and limitations of polysaccharide vaccines in infancy [J].
Cadoz, M .
VACCINE, 1998, 16 (14-15) :1391-1395