Heart transplantation across the antibodies against HLA and ABO

• We have intentionally performed heart transplantation in a 5-year-old child, despite the most unfavourable risk factors for patient survival; the presence of high level of antibodies against donor's human leucocyte antigen (HLA) class I/II and blood group antigens. Pretransplant treatment by mycophenolate mofetil, prednisolone, tacrolimus, intravenous immunoglobulin, rituximab, protein-A immunoadsorption (IA) and plasma exchange reduced antibody titres against the donor's lymphocytes from 128 to 16 and against the donor's blood group antigen from 256 to 0. The patient was urgently transplanted with a heart from an ABO incompatible donor (A(1) to O). A standard triple-drug immunosuppressive protocol was used. No hyperacute rejection was seen. Antibodies against the donor's HLA antigens remained at a low level despite three acute rejections. Rising anti-A(1) blood group antibodies preceded the second rejection and were reduced by two blood group-specific IAs and remained at a low level. The patient is doing well despite the persistence of donor-reactive antibodies.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Keyword

ABO Blood-Group System/immunology

Antibodies, Monoclonal/therapeutic use

Antibodies, Monoclonal, Murine-Derived

Child, Preschool

Drug Therapy, Combination

Female

Graft Rejection

Graft Survival

HLA Antigens/immunology

Heart Transplantation/methods

Humans

Immunoglobulins, Intravenous/therapeutic use

Immunosuppressive Agents/pharmacology

Lymphocytes/immunology

Mycophenolic Acid/analogs & derivatives

Plasma Exchange

Prednisolone/therapeutic use

Rituximab

Staphylococcal Protein A/immunology

Tacrolimus/therapeutic use

Time Factors

Publication and Content Type

art (subject category)

ref (subject category)