Issitt R W, Crook R M, Cross N T, Shaw M, Robertson A, Burch M, Hsia T Y, Tsang V T
Department of Clinical Perfusion Science, Great Ormond Street Children's Hospital, London, UK.
Perfusion. 2012 Nov;27(6):480-5. doi: 10.1177/0267659112453076. Epub 2012 Jul 6.
A decade ago, the first series of ABO-incompatible heart transplants was published, with surprising and extremely promising results; drastically reduced waiting list mortalities of infants listed for heart transplantation. Essential to the procedure was the process of plasma exchange transfusion, required to reduce isohaemagglutinin titres and facilitate the crossing of ABO blood group boundaries. Since then, Great Ormond Street Hospital, London has offered ABO-incompatible heart transplants to infants who potentially would die waiting for a suitable organ. We report the results of a decade of evolving plasma exchange experience and its impact upon patient selection.
A retrospective analysis was undertaken of all elective ABO-incompatible heart transplants at Great Ormond Street Children's Hospital from January 2001 until January 2011. Data were sought on underlying conditions and demographics of the patients, the isohaemagglutinin titre before and after plasma exchange and survival figures to date.
Twenty-one patients underwent ABO-incompatible heart transplantation, ranging from 3 to 44 months, with preoperative isohaemagglutinin titres ranging from 0 to 1:32. All patients underwent a "3 times" plasma exchange before transplantation, requiring exchange volumes of up to 3209 mL. Postoperative isohaemagglutinin titres ranged from 0 to 1:16. One patient died of causes unrelated to organ rejection.
Our data showed that eight patients (38.1%) were older than the previously suggested 12-month cut-off age. Using a combination of adult reservoir/paediatric oxygenator and extracorporeal circuit, ABO-incompatible plasma exchange transfusions can be undertaken safely using a simplified '3 times' method, reducing the circulating levels of isohaemagglutinins whilst providing minimal circuit size. This allows ABO-incompatible heart transplantation in a broader patient population than previously reported.
十年前，首批一系列ABO血型不相容心脏移植的报告公布，结果令人惊讶且前景极为乐观；心脏移植登记患儿的等待名单死亡率大幅降低。该手术的关键是血浆置换输血过程，这是降低同种血凝素滴度并促进跨越ABO血型界限所必需的。从那时起，伦敦大奥蒙德街医院就为那些可能在等待合适器官过程中死亡的婴儿提供ABO血型不相容心脏移植。我们报告了十年间不断发展的血浆置换经验及其对患者选择的影响。
对2001年1月至2011年1月在大奥蒙德街儿童医院进行的所有择期ABO血型不相容心脏移植进行回顾性分析。收集患者的基础疾病和人口统计学数据、血浆置换前后的同种血凝素滴度以及迄今为止的生存数据。
21例患者接受了ABO血型不相容心脏移植，年龄在3至44个月之间，术前同种血凝素滴度在0至1:32之间。所有患者在移植前均接受了“三次”血浆置换，置换量高达3209毫升。术后同种血凝素滴度在0至1:16之间。1例患者死于与器官排斥无关的原因。
我们的数据显示，8例患者（38.1%）年龄超过了之前建议的12个月临界年龄。使用成人储血器/小儿氧合器和体外循环的组合，采用简化的“三次”方法可以安全地进行ABO血型不相容血浆置换输血，降低同种血凝素的循环水平，同时使体外循环规模最小化。这使得ABO血型不相容心脏移植能够在比之前报道的更广泛的患者群体中进行。
