ABO-incompatible heart transplantation-evolution of a revolution

Neha Bansal; Lori J West; Jacob Simmonds; Simon Urschel

doi:10.1016/j.healun.2024.03.019

ABO-incompatible heart transplantation-evolution of a revolution

J Heart Lung Transplant. 2024 Apr 9:S1053-2498(24)01561-4. doi: 10.1016/j.healun.2024.03.019. Online ahead of print.

Authors

Neha Bansal¹, Lori J West², Jacob Simmonds³, Simon Urschel²

Affiliations

¹ Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, New York.
² Department of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada.
³ Pediatric Cardiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.

PMID: 38604353
DOI: 10.1016/j.healun.2024.03.019

Abstract

In the 1990s, neonates born with severe congenital heart disease faced more than 50% mortality awaiting an ABO-compatible (ABOc) transplant donor. This desperate situation, together with knowledge of gaps in the adaptive immune system in early childhood, led to the clinical exploration of intentional ABO-incompatible (ABOi) heart transplantation. In 2001, West et al. reported the first series of 10 infants in Canada. Since then, consideration of ABOi heart donors has become the standard of care for children awaiting transplantation in the first few years of life, resulting in reduced wait times and better organ utilization with noninferior post-transplant outcomes compared to ABOc recipients. This state-of-the-art review discusses the clinical development and evolution, underlying and resulting immunological aspects, current challenges, and future directions of ABOi heart transplantation.

Keywords: ABO-incompatible heart transplantation; T-independent B-cell response; blood group tolerance; immature immune system; pediatric transplantation.

Publication types

Review