Successful ABO incompatible heart transplantation after desensitization therapy in an older child

• Published in: Pediatric transplantation Vol. 27; no. 3; pp. e14459 - n/a
• Main Authors: Krauss, Annemarie, West, Lori J., Conway, Jennifer, Khoury, Michael, Nahirniak, Susann, Halpin, Anne, Al Aklabi, Mohammed, Urschel, Simon
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.05.2023
• Subjects: ABO Blood-Group System; ABO incompatibility; ABO system; Adolescent; Blood group A; Blood Group Incompatibility; Blood group O; Case reports; Child; Child, Preschool; children; desensitization; Graft Rejection; Heart Transplantation; Hemagglutinins; Humans; Immune system; Immunoglobulins; Living Donors; Rituximab; Rituximab - therapeutic use; children; heart transplantation; ABO incompatibility; desensitization
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.14459

Background ABO‐incompatible heart transplantation (HTx) has become a standard procedure for children below 2 years of age due to an immunologically immature immune system and associated low isohemagglutinin titers. Methods We report a case of an ABO‐incompatible HTx (recipient blood group O, donor blood group A) at the age of 5 years and 11 months with a fully matured immune system and previously high isohemagglutinin titers that diminished as a result of human leucocyte antigen (HLA) desensitization therapy with rituximab and immunoglobulins. Results The anti‐A titer at the time of HTx was 1:16 with post‐transplant isoagglutinin titers never exceeding 1:4 without any signs of rejection with now 3 years of post‐HTx follow‐up. Conclusions ABO isohemagglutinin titers should be routinely assessed in children undergoing desensitization therapy since ABOi transplantation can be considered in selected cases to expand the donor pool with the option of crossing the ABO barrier to find a better‐matched allograft.