TY - JOUR
T1 - Successful management of a B-type cardiac allograft into an O-type man with 3 1/2-year clinical follow-up
AU - Mohacsi, Paul
AU - Rieben, Robert
AU - Sigurdsson, Gisli
AU - Tschanz, Hansueli
AU - Schaffner, Thomas
AU - Nydegger, Urs E.
AU - Carrel, Thierry
PY - 2001/10/15
Y1 - 2001/10/15
N2 - Background. In May 1997, a 19-year-old male patient of histo-blood group type O suffering from congenital end-stage heart failure accidentally received a cardiac allograft of type B and is still alive in fair condition. Methods. In addition to conventional immunosuppressive therapy, plasma exchange (PEX), extracorporeal immunoabsorption (EIA), intravenous immunoglobulins (IVIG), and C1 inhibitor were used. Results. Such treatment successfully reduced both IgM and IgG anti-B levels and complement hyperactivity and allowed to reach the state of accommodation without obvious signs of rejection. The patient has been surviving for 42 months; retransplantation with an O-type heart remained unnecessary. Conclusion. Humoral rejection has been avoided in this patient, with PEX, EIA, IVIG, and C1 inhibitor substantially contributing to this success. With future availability of such combined therapies, preferably before transplantation, vascular rejection events caused by preformed antibodies and complement (ABO mismatch or anti-HLA) could be prevented or treated.
AB - Background. In May 1997, a 19-year-old male patient of histo-blood group type O suffering from congenital end-stage heart failure accidentally received a cardiac allograft of type B and is still alive in fair condition. Methods. In addition to conventional immunosuppressive therapy, plasma exchange (PEX), extracorporeal immunoabsorption (EIA), intravenous immunoglobulins (IVIG), and C1 inhibitor were used. Results. Such treatment successfully reduced both IgM and IgG anti-B levels and complement hyperactivity and allowed to reach the state of accommodation without obvious signs of rejection. The patient has been surviving for 42 months; retransplantation with an O-type heart remained unnecessary. Conclusion. Humoral rejection has been avoided in this patient, with PEX, EIA, IVIG, and C1 inhibitor substantially contributing to this success. With future availability of such combined therapies, preferably before transplantation, vascular rejection events caused by preformed antibodies and complement (ABO mismatch or anti-HLA) could be prevented or treated.
UR - http://www.scopus.com/inward/record.url?scp=0035886103&partnerID=8YFLogxK
U2 - 10.1097/00007890-200110150-00026
DO - 10.1097/00007890-200110150-00026
M3 - Article
C2 - 11602865
AN - SCOPUS:0035886103
SN - 0041-1337
VL - 72
SP - 1328
EP - 1330
JO - Transplantation
JF - Transplantation
IS - 7
ER -