ABO-incompatible hearts for infant transplantation

West, Lori J.

doi:10.1097/mot.0b013e32834a97a5

Cited by 22 publications

(16 citation statements)

References 42 publications

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“…West and co-workers have performed extensive research and have contributed a comprehensive review [78]. ABO antibodies can cause hyperacute or acute rejection, but patients in whom the antibody has been transiently reduced by various techniques have undergone successful transplantation [79].…”

Section: Comparison With Human Pathologymentioning

confidence: 99%

Role of complement and NK cells in antibody mediated rejection

et al. 2012

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Despite extensive research on T cells and potent immunosuppressive regimens that target cellular mediated rejection, few regimens have been proved to be effective on antibody-mediated rejection (AMR), particularly in the chronic setting. C4d deposition in the graft has been proved to be a useful marker for AMR; however, there is an imperfect association between C4d and AMR. While complement has been considered as the main player in acute AMR, the effector mechanisms in chronic AMR are still debated. Recent studies support the role of NK cells and direct effects of antibody on endothelium cells in a mechanism suggesting the presence of a complement-independent pathway. Here, we review the history, currently available systems and progress in experimental animal research. Although there are consistent findings from human and animal research, transposing the experimental results from rodent to human has been hampered by the differences in endothelial functions between species. We briefly describe the findings from patients and compare them with results from animals, to propose a combined perspective.

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Section: Comparison With Human Pathologymentioning

confidence: 99%

Role of complement and NK cells in antibody mediated rejection

et al. 2012

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“…Correctable heart defects like atrial septal defect and ventricular septal defect are not contraindications to donor graft utilization. As discussed earlier, studies indicate good outcomes with ABO-incompatible heart transplants in infants (7). This strategy has increased donor utilization, but has not resulted in a decrease in waiting-list mortality in the United States.…”

Section: Donor Evaluationmentioning

confidence: 96%

Neonatal heart transplantation

John

Bailey

2018

Ann. Cardiothorac. Surg.

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Neonatal heart transplantation was developed and established in the 1980's as a durable modality of therapy for complex-uncorrectable heart disease. Patients transplanted in the neonatal period have experienced unparalleled long-term survival, better than for any other form of solid-organ transplantation. However, the limited availability of neonatal and young infant donors has restricted the indications and applicability of heart transplantation among newborns in the current era. Indications for heart transplantation include congenital heart disease not amenable to other forms of surgical palliation, and cardiomyopathy, including some primary tumors. Use of ABO-incompatible transplants, and organs with prolonged cold ischemic time or marginal function have all been associated with good outcomes in infants. These extended strategies to increase the donor pool may also someday include donation after determination of circulatory death and the use of anencephalic donors. The operative techniques for donors and recipients of neonatal heart transplantation are unique and have been well-described. Immunosuppression protocols for neonates need not include induction and are largely steroid-free. Newborn and young infant transplant recipients have fewer episodes of rejection, less coronary allograft vasculopathy, less post-transplant lymphoproliferative disease and less renal dysfunction than their older counterparts. Long-term outcomes have been very encouraging in terms of graft survival, patient survival, and quality of life. Our review highlights the history, current indications, techniques and outcomes of heart transplantation in this immunologically-privileged subset of patients.

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“…Studies pioneered by Lori West’s group from Canada have brought new understandings to the mechanisms of graft acceptance in this unique paediatric population (Fan et al. , 2004; West, 2005, 2006, 2011). In the United States, although there has been a significant increase in ABO‐incompatible paediatric heart transplantation from 0% before 2002 to more than 53% in 2007, there is still preferential use mainly for sicker candidates (Almond et al.…”

Section: Status Of Abo‐incompatible Transplantsmentioning

confidence: 99%

“…, 2010). Policies and regulations for the utilization of ABO‐incompatible donors for paediatric heart transplantations are needed, to implement its widespread use in both the North American and European centres (West, 2011).…”

Section: Status Of Abo‐incompatible Transplantsmentioning

confidence: 99%

ABO‐incompatible organ transplantation

Subramanian

Ramachandran

Klein

et al. 2012

Int J Immunogenetics

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Increases in the patients on the organ transplant wait list have far out paced the number of available organs. This has lead to longer time awaiting transplantation and thus increased morbidity and mortality associated with it. Making more organs available for transplantation remains critical, and hence, extended criteria donors and ABO-incompatible organs are being utilized. Recent reports on the use of conventional immunosuppressive regimens for ABO-incompatible grafts suggest outcomes can be obtained similar to those of ABO-compatible transplants. The delay in the development of natural antibodies to ABO antigens in infants provides an 'immunological window' that allows for successful ABO-incompatible transplants in this age group. This also allows for a unique mechanism long-term tolerance to the graft in infants. ABO incompatibility may no longer be a contraindication in case of kidney transplantation and paediatric heart transplantation. Increased utilization of ABO-incompatible grafts can alleviate the shortage for organs and decrease waitlist times and associated morbidity. In this review, we will discuss the current status of ABO-incompatible transplantation in adult and paediatric solid organ transplantation with attention on recent developments on understanding the mechanisms of graft acceptance in these ABO-incompatible organs.

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ABO-incompatible hearts for infant transplantation

Abstract: ABOi heart transplantation is one example in which immunologic immaturity has been exploited to the advantage of pediatric transplant recipients. In-depth exploration of transplant-related immunobiology in the young may reveal further opportunities.

Cited by 22 publications

References 42 publications

Role of complement and NK cells in antibody mediated rejection

Role of complement and NK cells in antibody mediated rejection

Neonatal heart transplantation

ABO‐incompatible organ transplantation

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