Division of Pediatric Cardiology at the University of Alberta, Deutsches Herzzentrum, Berlin, Germany.
Departments of Pediatrics, Surgery, Medical Microbiology/Immunology and Laboratory Medicine/Pathology, University of Alberta, Alberta Transplant Institute, Edmonton, Alberta, Canada.
Pediatr Transplant. 2023 May;27(3):e14459. doi: 10.1111/petr.14459. Epub 2023 Jan 3.
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.
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.
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.
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.
由于免疫系统不成熟和相关的低同种血凝素滴度，ABO 不相容心脏移植（HTx）已成为 2 岁以下儿童的标准程序。
我们报告了一例 5 岁零 11 个月大的具有完全成熟的免疫系统和先前高同种血凝素滴度的 ABO 不相容 HTx（受者血型 O，供者血型 A），其同种血凝素滴度因利妥昔单抗和免疫球蛋白的 HLA 脱敏治疗而降低。
HTx 时的抗 A 效价为 1:16，移植后同种异体血凝素效价从未超过 1:4，且无排斥迹象，目前 HTx 后随访 3 年。
接受脱敏治疗的儿童应常规评估 ABO 同种血凝素滴度，因为在某些情况下可以考虑 ABOi 移植，以扩大供体库，通过跨越 ABO 障碍找到更好匹配的同种异体移植物。
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