Successful ABO‐incompatible heart transplantation in two infants

Summary In the pediatric age group shortage of donor hearts leads to mortality rates of 30–50% on the waiting list. Because of the immaturity of the immune system of infants, ABO‐incompatible heart transplantation may be an option to increase donor availability. We transplanted two infants with blood type O at the age of 7 and 5 months, respectively, with complex congenital heart disease. Intraoperative plasma exchange was performed during cardiopulmonary bypass followed by standard immunosuppression. Both recipients received a blood type A donor organ. Plasma was exchanged up to six times until anti‐A antibodies were eliminated. No hyperacute rejection occurred, ventricular function is excellent and there have been no acute rejection episodes up to 4 months after transplantation. Anti‐A antibody titers remained low and eventually disappeared. ABO‐incompatible cardiac transplantation shows good short‐term results in young infants and appears to be a safe procedure to reduce mortality on the waiting list.