Ott G Y, Norman D, Ratkovec R R, Hershberger R E, Hosenpud J D, Cobanoglu A
Oregon Cardiac Transplant Program, Oregon Health Sciences University, Portland 97201.
J Heart Lung Transplant. 1993 May-Jun;12(3):504-7.
Limited clinical experience concerning heart transplantation across ABO blood group barriers suggests a high incidence of hyperacute rejection and poor patient outcome. Reported is a case of the short-term survival of an ABO-mismatched cardiac graft without evident adverse immunologic effects. A 41-year-old man with blood type O underwent heart transplantation receiving a blood type A2 donor organ. Cyclosporine-based immunosuppression was augmented with daily plasmapheresis and OKT3 therapy. Circulating anti-A antibodies were reduced quickly and held to a very low level with this regimen. The patient remained hemodynamically stable until retransplantation 4 days later. The explanted heart showed no evidence of cellular infiltrate or antibody deposition. Long-term success with the use of type A2 organs in type O recipients has been shown in select series with other types of solid organ transplants. Although this patient underwent retransplantation early, the lack of rejection phenomena gives evidence that the relatively low antigenicity of the A2 subtype may allow planned heart transplantation across this blood group barrier, either as a bridge or on a permanent basis.
关于跨越ABO血型屏障进行心脏移植的临床经验有限，提示超急性排斥反应发生率高且患者预后不佳。本文报道了1例ABO血型不匹配心脏移植受者短期存活且无明显不良免疫反应的病例。1例41岁O型血男性接受了心脏移植，供者为A2型血器官。以环孢素为基础的免疫抑制方案联合每日血浆置换及OKT3治疗。采用该方案后，循环抗A抗体迅速减少并维持在极低水平。患者血流动力学保持稳定，直至4天后再次移植。取出的心脏未显示细胞浸润或抗体沉积迹象。在其他类型实体器官移植的特定系列研究中，已证实O型受者使用A2型器官可获得长期成功。尽管该患者早期即进行了再次移植，但未出现排斥现象，这表明A2亚型相对较低的抗原性可能使跨越该血型屏障的计划性心脏移植成为可能，无论是作为过渡还是永久性移植。
