Blood type incompatible cardiac transplantation in young infants☆

Daebritz, Sabine; Schmoeckel, Michael; Mair, Helmut; Kozlik‐Feldmann, Rainer; Wittmann, Georg; Kowalski, Christian; Kaczmarek, Ingo; Reichart, Bruno

doi:10.1016/j.ejcts.2006.11.032

Cited by 28 publications

(18 citation statements)

References 15 publications

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“…7,13,14 These favorable results led to the acceptance of ABO-I organ transplantation in 2001 by the UNOS, which governs transplantation in the United States. Our study shows that although the number of infants listed as eligible for ABO-I transplant in the United States has steadily increased, such that approximately half of all infants listed for heart transplant are now eligible for an ABO-I organ, the number of ABO-I heart transplants performed in the United States remains low.…”

Section: Discussionmentioning

confidence: 93%

Effect of ABO-Incompatible Listing on Infant Heart Transplant Waitlist Outcomes: Analysis of the United Network for Organ Sharing (UNOS) Database

Everitt

Donaldson

Casper

et al. 2009

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 93%

Effect of ABO-Incompatible Listing on Infant Heart Transplant Waitlist Outcomes: Analysis of the United Network for Organ Sharing (UNOS) Database

Everitt

Donaldson

Casper

et al. 2009

The Journal of Heart and Lung Transplantation

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“…Some alloreactivity may actually facilitate graft tolerance, which clearly does occur in a significant number of patients (22,23), explained variously by the opposing theories of clonal exhaustion-deletion (24) or 'allo-immune homeostasis' (25). Infants are more 'tolerogenic', not entirely explained by these theories, as indicated by the clinical tolerance of ABO-incompatible organs in infant heart transplant recipients (26). A large study of outcomes from acute rejection in adult liver transplantation, where some rejection actually conveyed a graft outcome advantage, raised the question as to whether complete elimination of all rejection is really a desirable goal in liver transplantation (27).…”

Section: Shepherd Et Almentioning

confidence: 99%

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

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Rejection and infection are important adverse events after pediatric liver transplantation, not previously subject to concurrent risk analysis. Of 2291 children (<18 years), rejection occurred at least once in 46%, serious bacterial/fungal or viral infections in 52%. Infection caused more deaths than rejection (5.5% vs. 0.6% of patients, p < 0.001). Early rejection (<6 month) did not contribute to mortality or graft failure. Recurrent/chronic rejection was a risk in graft failure, but led to retransplant in only 1.6% of first grafts. Multivariate predictors of bacterial/fungal infection included recipient age (highest in infants), race, donor organ variants, bilirubin, anhepatic time, cyclosporin (vs. tacrolimus) and era of transplant (before 2002 vs. after 2002); serious viral infection predictors included donor organ variants, rejection, Epstein-Barr Virus (EBV) naivety and era; for rejection, predictors included age (lowest in infants), primary diagnosis, donor-recipient blood type mismatch, the use of cyclosporin (vs. tacrolimus), no induction and era. In pediatric liver transplantation, infection risk far exceeds that of rejection, which causes limited harm to the patient or graft, particularly in infants. Aggressive infection control, attention to modifiable factors such as pretransplant nutrition and donor organ options and rigorous age-specific review of the risk/benefit of choice and intensity of immunosuppressive regimes is warranted.

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“…ABO-incompatible heart transplantation at multiple centers (2004)(2005)(2006)(2007)(2008) Following our 2001 report, the safety of ABOi heart transplantation in young children was demonstrated with comparable success in case reports and small series from pediatric transplant centers in the UK [11,12], Germany [13,14], the USA [15] and Italy [16], confirming the principle that the risk of hyperacute AMR of ABOi heart grafts is low in patients without pre-existing, or with low titer, antibodies to the donor blood group. Moreover, implantation of an ABOi graft into an infant clearly was not a 'sensitizing' event stimulating rapid production of ABO-directed antibodies, likely due to immaturity of components necessary to generate an immune response to carbohydrate antigens.…”

mentioning

confidence: 65%