Successful Cardiac Transplantation Across an Abo Blood Group Barrier

Rj, Caruana; Gl, Zumbro; Rg, Hoff; Rn, Rao; Sa, Daspit

doi:10.1097/00007890-198809000-00034

Cited by 18 publications

(2 citation statements)

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“…Transplants with ABO‐incompatible hearts or lungs are rare. A successful case in cardiac transplant from blood group B into a blood group O recipient was reported in 1988 (128). Recently, 10 infants who had congenital heart disease or cardiomyopathy received heart transplants from ABO‐incompatible donors (129).…”

Section: The Range Of Antigens That Evoke Alloantibody Responses In Tmentioning

confidence: 99%

The role of B cells and alloantibody in the host response to human organ allografts

Vongwiwatana

Tasanarong

Hidalgo

et al. 2003

Immunological Reviews

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Some human organ transplants deteriorate slowly over a period of years, often developing characteristic syndromes: transplant glomerulopathy (TG) in kidneys, bronchiolitis obliterans in lungs, and coronary artery disease in hearts. In the past, we attributed late graft deterioration to "chronic rejection", a distinct but mysterious immunologic process different from conventional rejection. However, it is likely that much of chronic rejection is explained by conventional T-cell-mediated rejection (TMR), antibody-mediated rejection (AMR), and other insults. Recently, criteria have emerged to now permit us to diagnose AMR in kidney transplants, particularly C4d deposition in peritubular capillaries and circulating antibody against donor human leukocyte antigens (HLA). Some cases with AMR develop TG, although the relationship of TG to AMR is complex. Thus, a specific diagnosis of AMR in kidney can now be made, based on graft damage, C4d deposition, and donor-specific alloantibodies. Criteria for AMR in other organs must be defined. Not all late rejections are AMR; some deteriorating organs probably have smoldering TMR. The diagnosis of late ongoing AMR raises the possibility of treatment to suppress the alloantibody, but efficacy of the available treatments requires further study.

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Section: The Range Of Antigens That Evoke Alloantibody Responses In Tmentioning

confidence: 99%

The role of B cells and alloantibody in the host response to human organ allografts

Vongwiwatana

Tasanarong

Hidalgo

et al. 2003

Immunological Reviews

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“…The incompatible graft showed, on examination, diffuse destruction of the microvasculature and endothelial necrosis in larger vessels, associated with acute inflammation of vessels. One inadvertent, but successful, case in which a blood group O recipient was transplanted with a blood group B heart was reported by Caruana et al (1988). The patient was treated with plasmapheresis and ALG was added to the immunosupression.…”

Section: Abo Incompatible Heart or Heart/lung Transplantationsmentioning

confidence: 99%

ABO‐incompatibility in solid organ transplantation

Rydberg

2001

Transfusion Medicine

208

153

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The most important transplantation antigen system in solid organ transplantation is the ABO histo-blood group system. Crossing the ABO barrier in solid organ transplantation is usually not done except for emergency liver transplantations. Early experiences of crossing the ABO barrier in renal transplantation were very disappointing. In the 1970s, clinical trials were started transplanting kidneys of subgroup A2 into blood group O recipients. The tissues of the A2 subgroup expresses reduced amount of A antigens compared to subgroup A1 and the recipients had no special pretreatment and standard immunosuppression. A number of early graft losses were experienced but the trial also resulted in several long time surviving grafts. A few centres have adapted the concept of A2 to non A kidney transplantations with successful results, when the recipient anti-A titres are low or reduced prior to transplantation. In the early 1980s one group successfully transplanted A1 and B kidneys from living related donors across the ABO-barrier using an immunosuppressive protocol consisting of quadruple drugs and splenectomy and this protocol was adapted by a few other groups. In Japan, where cadaver donors are available in very limited number, the largest number of ABO-incompatible transplantations have been performed. Altogether more than 300 ABO-incompatible kidney transplantations have been performed in more than 40 centres since 1989. ABO-incompatible liver transplantations have been performed mainly in emergency cases and the results have generally been inferior to ABO-compatible grafts. In children below the age of three years, liver transplantations across the ABO-barrier have been quite successful especially with living related donors. Very few ABO-incompatible heart/heart-lung/lung-transplantations have been reported with a few successful cases, but the majority have been failures. Recently a series of ABO-incompatible heart transplants performed in small children have been reported with a high success rate.

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