Pushing the boundaries: The current status of ABO-incompatible cardiac transplantation

Irving, Claire; Gennery, Andrew R.; Kirk, Richard

doi:10.1016/j.healun.2012.03.007

Cited by 19 publications

(23 citation statements)

References 64 publications

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“…Lori West has shown that ABOi heart transplants can be performed in infants without the need for antibody depletion 105. In older children and adults, ABOi heart transplantation can be performed successfully using the various desensitization protocols applied to ABOi kidney transplantation (reviewed in 106). …”

Section: Outcomes Of Transplantation After Desensitizationmentioning

confidence: 99%

Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

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Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft.

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Section: Outcomes Of Transplantation After Desensitizationmentioning

confidence: 99%

Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

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“…Unfortunately, the United States currently utilizes the ABO-incompatible waiting-list primarily for sicker children instead of using it to its full potential. 4 There is controversy over the maximum age limit for ABO-incompatible heart transplants. As stated previously, UNOS' policy is infants under 24 months with a titer assay less than or equal to 1:4.…”

Section: Discussionmentioning

confidence: 99%

“…2 At age 6-8 months, actual development of isohemagglutinins begins to appear after gut colonization with Escherichia coli (E. coli). [2][3][4]6 Monitoring for anti-A or anti-B antibody (isohemagglutinins) is crucial in determining whether the transplant will be successfully accepted or immediately rejected. Sudden intravascular activation of the complement system occurs when blood group antigens on the endothelial cells of the donor organ react with recipient antibodies.…”

Section: Introductionmentioning

confidence: 99%

ABO-incompatible heart transplants

et al. 2014

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A month-old baby girl with blood type O positive received a donor heart organ from a donor with blood type B. This was the first institutional ABO-incompatible heart transplant. Infants listed for transplantation may be considered for an ABO-incompatible heart transplant based on their antibody levels and age. The United Network of Organ Sharing (UNOS) protocol is infants under 24 months with titers less than or equal to 1:4.(1) This recipient's anti-A and anti-B antibodies were monitored with titer assays to determine their levels; antibody levels less than 1:4 are acceptable pre-transplant in order to proceed with donor and transplant arrangements.1 Immediately prior to initiating cardiopulmonary bypass (CPB), a complete whole body exchange transfusion of at least two-times the patient's circulating blood volume was performed with packed red blood cells (pRBC), fresh frozen plasma (FFP) and 25% albumin. Titer assays were sent two minutes after initiation of full CPB and then hourly until the cross-clamp was removed. Institutionally, reperfusion of the donor heart is not restored until the antibody level from the titer assay is known and reported as less than 1:4; failing to achieve an immulogically tolerant recipient will provide conditions for hyperacute rejection. The blood collected during the transfusion exchange was immediately processed through a cell saver so the pRBC's could be re-infused to the patient during CPB, as necessary. The remainder of the transplant was performed in the same fashion as an ABO-compatible heart transplant. The patient has shown no signs of rejection following transplantation.

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“…45 In vivo studies of BLyS have shown efficacy in deleting novel alloreactive antibodies at an early stage in B-cell lifespan. 48 The ability to perform ABO-incompatible transplantation provides a model to enhance our understanding of immune tolerance and manage what are currently considered HLA-incompatible donors and recipients. 46 Beyond immunosuppressive therapies, the ability to perform ABO-incompatible heart transplantation in infants with precision provides an opportunity for methodical understanding of accommodation.…”

Section: How S Hould Patients Underg O De S En S Itiz Ati On?mentioning

confidence: 99%

“…47 Interestingly, after ABO-incompatible heart transplantation, recipients have shown a lower prevalence of HLA class II antibodies. 48 The ability to perform ABO-incompatible transplantation provides a model to enhance our understanding of immune tolerance and manage what are currently considered HLA-incompatible donors and recipients.…”

Section: How S Hould Patients Underg O De S En S Itiz Ati On?mentioning

confidence: 99%

Desensitization in heart transplant recipients: Who, when, and how

Shah

Patel

2019

Clinical Transplantation

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The number of heart transplant candidates who have pre-formed antibodies against human leukocyte antigens (HLAs) is increasing over time. The purpose of this review is to discuss the process of antibody desensitization for heart transplant candidates. Specifically, we review the current status of antibody detection including identification, strength, and potential pathogenicity. We discuss which patients and when should they undergo desensitization therapies during heart transplant evaluation. Specific therapies including mechanical removal of antibodies, intravenous immunoglobulins, and novel immunosuppressive agents targeting antibody production will be discussed. Finally, future research strategies to develop novel desensitization therapies for heart transplant candidates will be reviewed. K E Y W O R D Sdesensitization, heart disease, sensitization

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Pushing the boundaries: The current status of ABO-incompatible cardiac transplantation

Cited by 19 publications

References 64 publications

Desensitization for solid organ and hematopoietic stem cell transplantation

Desensitization for solid organ and hematopoietic stem cell transplantation

ABO-incompatible heart transplants

Desensitization in heart transplant recipients: Who, when, and how

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