Even if the blood types of a donor and recipient are incompatible, heart transplantation can be performed safely in infants because their immune systems are so immature, Lori J. West, MD, of the Hospital for Sick Children and colleagues reported on March 15 in The New England Journal of Medicine (2001;344:793-800).
The authors studied 10 infants from 4 hours to 14 months old who had congenital heart disease or cardiomyopathy and who received new hearts with ABO-incompatible blood types. With follow-up ranging from 11 months to 4.6 years, the overall survival was 80%, but the two deaths among the 10 patients were presumed to be unrelated to ABO incompatibility. The infants were given immunosuppressive drugs at surgery and afterward; no hyperacute rejection occurred; and no morbidity was observed related to blood incompatibility.
"Because of the use of ABO-incompatible donors, the mortality rate among infants on the waiting list declined from 58% to 7%," the authors reported.
Although Dr. West and colleagues said they had not determined the maximum age at which ABO-incompatible hearts could be safely used, they concluded that "the appropriate population could include all infants in whom serum isohemagglutinins have not yet developed."
An editorial in the journal by Mark M. Boucek, MD, of the University of Colorado noted that the number of children in the study was small, and they were not followed for a long time (2001; 344:843-844). Although further research is needed "before a wholesale change is implemented" in the way organs are allocated, Dr. Boucek wrote, the new study "points the way to treating more infants who would otherwise die."
For Your Information:
- Read the abstract at www.nejm.org/content/2001/0344/0011/0793.asp
- and the full text of the editorial at www.nejm.org/content/2001/0344/0011/0843.asp
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