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ABO-incompatible heart transplants appear safe in infants; finding could reduce waiting time for donor organs.

ABO-incompatible heart transplantation may be performed safely during infancy and has the potential to significantly reduce mortality rates by decreasing waiting times for donor organs, Canadian researchers reported in the March 15th issue of the New England Journal of Medicine.

Lori West, MD of the University of Toronto and colleagues studied 10 infants, 4 hours to 14 months old, with congenital heart disease or cardiomyopathy who received heart transplants from donors of incompatible blood types. Overall survival during 11 months to 4.6 years of follow-up was 80%, which is comparable to ABO-compatible transplants. Due to the immaturity of the babies' immune systems, the researchers said none experienced hyperacute rejection, and no morbidity was attributable to ABO incompatibility. Furthermore, despite the eventual development of antibodies to antigens of the donor's blood group in 2 of the infants, their grafts were not damaged. Because of the use of hearts from ABO-incompatible donors, the mortality rate among the infants on the waiting list declined from 58% to 7%.

"The generally good results in this series reflect the fundamental malleability of young infants," wrote West and co-authors. "These infants were desperately ill at the time of transplantation, most with severe cardiac malformations. Their highest risk of mortality derived from the insufficient availability of ABO-compatible donors." While the maximal age at which this protocol may be used safely has yet to be determined, the investigators said, "the appropriate population could include all infants in whom [blood group] isohem agglutinins have not yet developed."

The availability of donors is a major factor limiting heart transplantation in infants. Yet UNOS data indicate that a large number of suitable hearts from babies and children go unused, often because the potential donors have blood type AB, B, or even A, and an ABO-compatible recipient is not found during the brief period when the donor heart is available, wrote Mark Boucek, MD of the University of Colorado in Denver in an accompanying editorial. "If the results reported by West et al. can be confirmed, the effects on the rate of use of available hearts will be substantial," he predicted.
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Comment:ABO-incompatible heart transplants appear safe in infants; finding could reduce waiting time for donor organs.
Publication:Transplant News
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 30, 2001
Words:350
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