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Heart transplantation across the antibodies against HLA and ABO

Bucin, Dragan ; Johansson, Sune LU ; Malm, Torsten LU ; Jögi, Peeter LU ; Johansson, Jens LU ; Westrin, Per LU ; Lindberg, Lars LU ; Olsson, Ann-Kristin LU ; Gelberg, Jan LU and Peres, Valeria , et al. (2006) In Transplant International 19(3). p.239-244
Abstract

We have intentionally performed heart transplantation in a 5-year-old child, despite the most unfavourable risk factors for patient survival; the presence of high level of antibodies against donor's human leucocyte antigen (HLA) class I/II and blood group antigens. Pretransplant treatment by mycophenolate mofetil, prednisolone, tacrolimus, intravenous immunoglobulin, rituximab, protein-A immunoadsorption (IA) and plasma exchange reduced antibody titres against the donor's lymphocytes from 128 to 16 and against the donor's blood group antigen from 256 to 0. The patient was urgently transplanted with a heart from an ABO incompatible donor (A(1) to O). A standard triple-drug immunosuppressive protocol was used. No hyperacute rejection was... (More)

We have intentionally performed heart transplantation in a 5-year-old child, despite the most unfavourable risk factors for patient survival; the presence of high level of antibodies against donor's human leucocyte antigen (HLA) class I/II and blood group antigens. Pretransplant treatment by mycophenolate mofetil, prednisolone, tacrolimus, intravenous immunoglobulin, rituximab, protein-A immunoadsorption (IA) and plasma exchange reduced antibody titres against the donor's lymphocytes from 128 to 16 and against the donor's blood group antigen from 256 to 0. The patient was urgently transplanted with a heart from an ABO incompatible donor (A(1) to O). A standard triple-drug immunosuppressive protocol was used. No hyperacute rejection was seen. Antibodies against the donor's HLA antigens remained at a low level despite three acute rejections. Rising anti-A(1) blood group antibodies preceded the second rejection and were reduced by two blood group-specific IAs and remained at a low level. The patient is doing well despite the persistence of donor-reactive antibodies.

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ABO Blood-Group System/immunology, Antibodies, Monoclonal/therapeutic use, Antibodies, Monoclonal, Murine-Derived, Child, Preschool, Drug Therapy, Combination, Female, Graft Rejection, Graft Survival, HLA Antigens/immunology, Heart Transplantation/methods, Humans, Immunoglobulins, Intravenous/therapeutic use, Immunosuppressive Agents/pharmacology, Lymphocytes/immunology, Mycophenolic Acid/analogs & derivatives, Plasma Exchange, Prednisolone/therapeutic use, Rituximab, Staphylococcal Protein A/immunology, Tacrolimus/therapeutic use, Time Factors
in
Transplant International
volume
19
issue
3
pages
6 pages
publisher
Springer
external identifiers
  • wos:000234985600010
  • pmid:16441774
  • scopus:33645343027
  • pmid:16441774
ISSN
1432-2277
DOI
10.1111/j.1432-2277.2005.00260.xhttps://doi.org/10.1111/j.1432-2277.2005.00260.x
language
English
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yes
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The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Section I-II (013230011), Division III (013230700), Anaesthesiology and Intensive Care (013230022), Department of Nephrology (013230024), Cardiology (013230026), Division of Infection Medicine (SUS) (013008000), Thoracic Surgery (013230027), Department of Clinical Sciences, Lund (013230000)
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c9d7b40f-1dde-437b-b7db-9a9207b0f794 (old id 150047)
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16441774&dopt=Abstract
date added to LUP
2016-04-01 16:40:47
date last changed
2020-01-12 19:37:39
@article{c9d7b40f-1dde-437b-b7db-9a9207b0f794,
  abstract     = {<p>We have intentionally performed heart transplantation in a 5-year-old child, despite the most unfavourable risk factors for patient survival; the presence of high level of antibodies against donor's human leucocyte antigen (HLA) class I/II and blood group antigens. Pretransplant treatment by mycophenolate mofetil, prednisolone, tacrolimus, intravenous immunoglobulin, rituximab, protein-A immunoadsorption (IA) and plasma exchange reduced antibody titres against the donor's lymphocytes from 128 to 16 and against the donor's blood group antigen from 256 to 0. The patient was urgently transplanted with a heart from an ABO incompatible donor (A(1) to O). A standard triple-drug immunosuppressive protocol was used. No hyperacute rejection was seen. Antibodies against the donor's HLA antigens remained at a low level despite three acute rejections. Rising anti-A(1) blood group antibodies preceded the second rejection and were reduced by two blood group-specific IAs and remained at a low level. The patient is doing well despite the persistence of donor-reactive antibodies.</p>},
  author       = {Bucin, Dragan and Johansson, Sune and Malm, Torsten and Jögi, Peeter and Johansson, Jens and Westrin, Per and Lindberg, Lars and Olsson, Ann-Kristin and Gelberg, Jan and Peres, Valeria and Harling, Solweig and Bennhagen, Rolf and Kornhall, Björn and Ekmehag, Björn and Kurkus, Jan and Otto, Gisela},
  issn         = {1432-2277},
  language     = {eng},
  number       = {3},
  pages        = {239--244},
  publisher    = {Springer},
  series       = {Transplant International},
  title        = {Heart transplantation across the antibodies against HLA and ABO},
  url          = {http://dx.doi.org/10.1111/j.1432-2277.2005.00260.xhttps://doi.org/10.1111/j.1432-2277.2005.00260.x},
  doi          = {10.1111/j.1432-2277.2005.00260.xhttps://doi.org/10.1111/j.1432-2277.2005.00260.x},
  volume       = {19},
  year         = {2006},
}