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'''ABO-incompatible (ABOi) transplantation''' is a method of allocation in [[organ transplantation]] that permits more efficient use of available organs, which would otherwise be unavailable due to [[Transplant rejection#Hyperacute rejection|hyperacute rejection]]<ref name="west2006">West, L. J., Karamlou, T., Dipchand, A. I., Pollock-Barziv, S. M., Coles, J. G., & McCrindle, B. W. (2006). Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. The Journal of Thoracic and Cardiovascular Surgery, 131(2), 455–461. doi:10.1016/j.jtcvs.2005.09.048</ref>. Primarily in use in infants and young toddlers, research is ongoing to allow for this capability in adult transplants.
'''ABO-incompatible (ABOi) transplantation''' is a method of allocation in [[organ transplantation]] that permits more efficient use of available organs, which would otherwise be unavailable due to [[Transplant rejection#Hyperacute rejection|hyperacute rejection]].<ref name="west2006">West, L. J., Karamlou, T., Dipchand, A. I., Pollock-Barziv, S. M., Coles, J. G., & McCrindle, B. W. (2006). Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. The Journal of Thoracic and Cardiovascular Surgery, 131(2), 455–461. doi:10.1016/j.jtcvs.2005.09.048</ref><ref name="schmoeckel2005">Schmoeckel, M., Däbritz, S. H., Kozlik-Feldmann, R., Wittmann, G., Christ, F., Kowalski, C., et al. (2005). Successful ABO-incompatible heart transplantation in two infants. Transplant International, 18(10), 1210–1214. doi:10.1111/j.1432-2277.2005.00181.x</ref> Primarily in use in infants and young toddlers, research is ongoing to allow for this capability in adult transplants. Normal ABO-compatibility rules may be observed for all recipients.<ref name="schmoeckel2005" /> This means that anyone may receive a transplant of a type-O organ, and consequently, type-O recipients (the rarest) are one of the biggest beneficiaries of ABO-incompatible transplants.<ref name="schmoeckel2005" />


== ABO-incompatible transplantation in young children ==
== ABO-incompatible transplantation in young children ==


Because very young children (generally under 12 months, but often as old as 24 months<ref name="west2009">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</ref>) do not have a well-developed [[immune system]],<ref name="west2001">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</ref> 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 transplant]]ation reduced infant mortality from 58% to 7%.<ref name="west2001" /> Graft survival and patient mortality is approximately the same between ABOi and ABOc recipients.<ref name="saczkowski2010">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</ref><ref name="stewart2009">Stewart, Z. A., Locke, J. E., Montgomery, R. A., Singer, A. L., Cameron, A. M., & Segev, D. L. (2009). ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 15(8), 883–893. doi:10.1002/lt.21723</ref> This was found to not only allow for better allocation of organs among donors, but improved graft ischemia by reducing the time required to transport organs to prospective patients.<ref name="west2006" /> Children are more likely to be listed for ABOi transplantation if they are [[United Network for Organ Sharing|UNOS]] status 1A (i.e. the most critical category.)<ref name="almond2010">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</ref> While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.<ref name="west2009" />
Because very young children (generally under 12 months, but often as old as 24 months<ref name="west2009">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</ref>) do not have a well-developed [[immune system]],<ref name="west2001">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</ref> 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 transplant]]ation reduced infant mortality from 58% to 7%.<ref name="west2001" /> Graft survival and patient mortality is approximately the same between ABOi and ABOc recipients.<ref name="west2006" /><ref name="saczkowski2010">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</ref><ref name="stewart2009">Stewart, Z. A., Locke, J. E., Montgomery, R. A., Singer, A. L., Cameron, A. M., & Segev, D. L. (2009). ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 15(8), 883–893. doi:10.1002/lt.21723</ref> This was found to not only allow for better allocation of organs among donors, but improved graft ischemia by reducing the time required to transport organs to prospective patients.<ref name="west2006" /> Children are more likely to be listed for ABOi transplantation if they are [[United Network for Organ Sharing|UNOS]] status 1A (i.e. the most critical category.)<ref name="almond2010">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</ref> While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.<ref name="west2009" />


The most important factors are that the recipient not have produced [[isohemagglutinin]]s, and that they have low levels of T cell-independent [[antigen]]s.<ref name="west2001" /><ref name="burch2004">Burch, M., & Aurora, P. (2004). Current status of paediatric heart, lung, and heart-lung transplantation. Archives of disease in childhood, 89(4), 386–389.</ref> UNOS regulations allow for ABOi transplantation in children under two years of age if isohemagglutinin titers are 1:4 or below,<ref name="unos_policy_3.7">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</ref><ref name="urschel2013">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</ref> and if there is no matching ABO-compatible (ABOc) recipient,<ref name="almond2010"/><ref name="unos_policy_3.7" /><ref name="urschel2013" /> though Canadian centers do not have this restriction.<ref name="west2009" /> 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.<ref name="fan2004">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</ref> 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.<ref name="west2009" /><ref name="urschel2013" />
The most important factors are that the recipient not have produced [[isohemagglutinin]]s, and that they have low levels of T cell-independent [[antigen]]s.<ref name="west2001" /><ref name="burch2004">Burch, M., & Aurora, P. (2004). Current status of paediatric heart, lung, and heart-lung transplantation. Archives of disease in childhood, 89(4), 386–389.</ref> UNOS regulations allow for ABOi transplantation in children under two years of age if isohemagglutinin titers are 1:4 or below,<ref name="unos_policy_3.7">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</ref><ref name="urschel2013">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</ref> and if there is no matching ABO-compatible (ABOc) recipient,<ref name="almond2010"/><ref name="unos_policy_3.7" /><ref name="urschel2013" /> though Canadian centers do not have this restriction.<ref name="west2009" /> 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.<ref name="fan2004">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</ref> 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.<ref name="west2009" /><ref name="urschel2013" />
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== ABO-incompatible transplantation in older children and adults ==
== ABO-incompatible transplantation in older children and adults ==
Limited success has been achieved in ABOi transplantation in adults,<ref name="tyden2012">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</ref> though this requires that the adult recipients have low levels of anti-A or anti-B antibodies.<ref name="tyden2012" /> Some organs are more conducive to adult ABOi transplant than others, such as liver<ref name="stewart2009" /> and kidney.<ref name="montgomery2012">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</ref> Adults are significantly likely to suffer from hyperacute rejection,<ref name="west2006" /> [[thrombosis]], or [[death]], but could be considered to be an acceptable risk if the alternative is otherwise death.<ref name="stewart2009" />
Limited success has been achieved in ABOi transplantation in adults,<ref name="tyden2012">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</ref> though this requires that the adult recipients have low levels of anti-A or anti-B antibodies.<ref name="tyden2012" /> Some organs are more conducive to adult ABOi transplant than others, such as liver<ref name="stewart2009" /> and kidney.<ref name="montgomery2012">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</ref><ref name="schmoeckel2005" /> Adults are significantly likely to suffer from hyperacute rejection,<ref name="west2006" /> [[thrombosis]], or [[death]], but could be considered to be an acceptable risk if the alternative is otherwise death.<ref name="stewart2009" /> In the case of ABOi kidney transplantation, aggressive antibody removal is required, along with supplemental medication.<ref name="urschel2013" />


== References ==
== References ==

Revision as of 03:11, 26 April 2013

ABO-incompatible (ABOi) transplantation is a method of allocation in organ transplantation that permits more efficient use of available organs, which would otherwise be unavailable due to hyperacute rejection.[1][2] Primarily in use in infants and young toddlers, research is ongoing to allow for this capability in adult transplants. Normal ABO-compatibility rules may be observed for all recipients.[2] This means that anyone may receive a transplant of a type-O organ, and consequently, type-O recipients (the rarest) are one of the biggest beneficiaries of ABO-incompatible transplants.[2]

ABO-incompatible transplantation in young children

Because very young children (generally under 12 months, but often as old as 24 months[3]) do not have a well-developed immune system,[4] 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%.[4] Graft survival and patient mortality is approximately the same between ABOi and ABOc recipients.[1][5][6] This was found to not only allow for better allocation of organs among donors, but improved graft ischemia by reducing the time required to transport organs to prospective patients.[1] Children are more likely to be listed for ABOi transplantation if they are UNOS status 1A (i.e. the most critical category.)[7] While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.[3]

The most important factors are that the recipient not have produced isohemagglutinins, and that they have low levels of T cell-independent antigens.[4][8] UNOS regulations allow for ABOi transplantation in children under two years of age if isohemagglutinin titers are 1:4 or below,[9][10] and if there is no matching ABO-compatible (ABOc) recipient,[7][9][10] though Canadian centers do not have this restriction.[3] 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.[11] 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.[3][10]

Intentional ABOi heart transplantation in infants was first conducted in 1996 by a team led by Dr. Lori J. West[12] at the Hospital for Sick Children in Toronto.

ABO-incompatible transplantation in older children and adults

Limited success has been achieved in ABOi transplantation in adults,[13] though this requires that the adult recipients have low levels of anti-A or anti-B antibodies.[13] Some organs are more conducive to adult ABOi transplant than others, such as liver[6] and kidney.[14][2] Adults are significantly likely to suffer from hyperacute rejection,[1] thrombosis, or death, but could be considered to be an acceptable risk if the alternative is otherwise death.[6] In the case of ABOi kidney transplantation, aggressive antibody removal is required, along with supplemental medication.[10]

References

  1. ^ a b c d West, L. J., Karamlou, T., Dipchand, A. I., Pollock-Barziv, S. M., Coles, J. G., & McCrindle, B. W. (2006). Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. The Journal of Thoracic and Cardiovascular Surgery, 131(2), 455–461. doi:10.1016/j.jtcvs.2005.09.048
  2. ^ a b c d Schmoeckel, M., Däbritz, S. H., Kozlik-Feldmann, R., Wittmann, G., Christ, F., Kowalski, C., et al. (2005). Successful ABO-incompatible heart transplantation in two infants. Transplant International, 18(10), 1210–1214. doi:10.1111/j.1432-2277.2005.00181.x
  3. ^ 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
  4. ^ 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
  5. ^ 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
  6. ^ a b c Stewart, Z. A., Locke, J. E., Montgomery, R. A., Singer, A. L., Cameron, A. M., & Segev, D. L. (2009). ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 15(8), 883–893. doi:10.1002/lt.21723
  7. ^ 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
  8. ^ Burch, M., & Aurora, P. (2004). Current status of paediatric heart, lung, and heart-lung transplantation. Archives of disease in childhood, 89(4), 386–389.
  9. ^ 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
  10. ^ a b c d 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
  11. ^ 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
  12. ^ Klein, A. A., Lewis, C. J., & Madsen, J. C. (2011). Organ Transplantation: A Clinical Guide. p.116. Cambridge University Press.
  13. ^ 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
  14. ^ 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
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