ABO-incompatible transplantation: Difference between revisions
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Revision as of 02:15, 7 April 2013
ABO-incompatible (ABOi) transplants are a method of allocation in organ transplantation that permits more efficient use of available organs, which would otherwise be unavailable due to acute rejection. Primarily in use in infants and young toddlers, research is ongoing to allow for this capability in adult transplants.
ABO-incompatible transplantation in young children
Because very young children (generally under 12 months, but often as old as 24 months[1]) do not have a well-developed immune system,[2] it is possible for them to receive organs from otherwise incompatible donors. This is known as ABO-incompatible (ABOi) transplantation. During the initial study period of 1996-2001, allowing for ABOi heart transplantation reduced infant mortality from 58% to 7%.[2] Graft survival and patient mortality is approximately the same between ABOi and ABOc recipients.[3][4] Children are more likely to be listed for ABOi transplantation if they are UNOS status 1A (i.e. the most critical category.)[5] While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.[1]
The most important factors are that the recipient not have produced isohemagglutinins, and that they have low levels of T cell-independent antigens.[6][2] UNOS regulations allow for ABOi transplantation in children under two years of age if isohemagglutinin titers are 1:4 or below,[7][8] and if there is no matching ABO-compatible (ABOc) recipient,[7][5][8] though Canadian centers do not have this restriction.[1] Studies have shown that the period under which a recipient may undergo ABOi transplantation may be prolonged by exposure to nonself A and B antigens.[9] Furthermore, should the recipient (for example, type B-positive with a type AB-positive graft) require eventual retransplantation, the recipient may receive a new organ of either blood type.[1]
ABO-incompatible transplantation in older children and adults
Limited success has been achieved in ABOi transplants in adults,[10] though this requires that the adult recipients have low levels of anti-A or anti-B antibodies.[10] Some organs are more conducive to adult ABOi transplant than others, such as liver[4] and kidney.[11] Adults are significantly likely to suffer from acute rejection, thrombosis, or death, but could be considered to be an acceptable risk if the alternative is otherwise death.[4]
References
- ^ a b c d ABO Incompatible Heart Transplantation in Young Infants. (2009, July 30). ABO Incompatible Heart Transplantation in Young Infants. American Society of Transplantation. Retrieved from http://www.myast.org/podcasts/abo-incompatible-heart-transplantation-young-infants
- ^ a b c West, L. J., Pollock-Barziv, S. M., Dipchand, A. I., Lee, K.-J. J., Cardella, C. J., Benson, L. N., et al. (2001). ABO-incompatible (ABOi) heart transplantation in infants. New England Journal of Medicine, 344(11), 793–800. doi:10.1056/NEJM200103153441102
- ^ Saczkowski, R., Dacey, C., & Bernier, P.-L. (2010). Does ABO-incompatible and ABO-compatible neonatal heart transplant have equivalent survival? Interactive cardiovascular and thoracic surgery, 10(6), 1026–1033. doi:10.1510/icvts.2009.229757
- ^ a b c ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. (2009). ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis., 15(8), 883–893. doi:10.1002/lt.21723
- ^ a b Almond, C. S. D., Gauvreau, K., Thiagarajan, R. R., Piercey, G. E., Blume, E. D., Smoot, L. B., et al. (2010). Impact of ABO-Incompatible Listing on Wait-List Outcomes Among Infants Listed for Heart Transplantation in the United States: A Propensity Analysis. Circulation, 121(17), 1926–1933. doi:10.1161/CIRCULATIONAHA.109.885756
- ^ Burch, M., & Aurora, P. (2004). Current status of paediatric heart, lung, and heart-lung transplantation. Archives of disease in childhood, 89(4), 386–389.
- ^ a b United Network for Organ Sharing. (2013, January 31). OPTN Policy 3.7 - Allocation of Thoracic Organs. Retrieved from http://optn.transplant.hrsa.gov/policiesAndBylaws/policies.asp
- ^ a b Urschel, S., Larsen, I. M., Kirk, R., Flett, J., Burch, M., Shaw, N. L., et al. (2013). ABO-incompatible heart transplantation in early childhood An international multicenter study of clinical experiences and limits. The Journal of Heart and Lung Transplantation, 32(3), 285–292. doi:10.1016/j.healun.2012.11.022
- ^ Fan, X., Ang, A., Pollock-Barziv, S. M., Dipchand, A. I., Ruiz, P., Wilson, G., et al. (2004). Donor-specific B-cell tolerance after ABO-incompatible infant heart transplantation. Nature medicine, 10(11), 1227–1233. doi:10.1038/nm1126
- ^ a b Tydén, G., Hagerman, I., Grinnemo, K.-H., Svenarud, P., van der Linden, J., Kumlien, G., & Wernerson, A. (2012). Intentional ABO-incompatible heart transplantation: a case report of 2 adult patients. The Journal of Heart and Lung Transplantation, 31(12), 1307–1310. doi:10.1016/j.healun.2012.09.011
- ^ Montgomery, J. R., Berger, J. C., Warren, D. S., James, N. T., Montgomery, R. A., & Segev, D. L. (2012). Outcomes of ABO-incompatible kidney transplantation in the United States. Transplantation, 93(6), 603–609. doi:10.1097/TP.0b013e318245b2af