UNOS Policy: ABO incompatible HTX for children up to 2 years (with acceptable isohaemoglutinin titres – less than 1:4)
| Recipient | Donor compatible | Donor incompatible | Antibodies to avoid | Plasma / Platelets | RBC |
| 0 | 0 | 0 | |||
| 0 | AB | Anti AAnti B | AB | 0 | |
| 0 | A | Anti A | AB or A | 0 | |
| 0 | B | Anti B | AB or B | 0 | |
| A | A | ||||
| A | 0 | ||||
| A | AB | Anti AAnti B | AB | A or 0 | |
| A | B | Anti AAnti B | AB | A or 0 | |
| B | B | ||||
| B | 0 | ||||
| B | AB | Anti AAnti B | AB | B or 0 | |
| B | A | Anti AAnti B | AB | B or 0 | |
| AB | AB | AB | |||
| AB | A | AB | |||
| AB | B | AB | |||
| AB | 0 | AB |
Preoperative preparation:
Isohaemagglutinin titres. Avoid transfusion. Consider transfusion in regards to guide.
Perioperative management:
If elevated iso-titre: plasma exchange once on CPB, iso-haemagglutinin quick test before AoCx release, repeat plasma exchange as required.
Postoperative management:
Isohaemaggluttinin titres daily of ABOi HTX. Repeat plasma exchange if required.
Outcome:
Similar long term outcome. Reduced rate of infection and rejection compared to ABO compatible blood transfusions.
References:
[1] Paediatric Heart Transplant Society: www.uab.edu/phts/
[2] Heart Lung Transplant. 2012 Feb;31(2):173-9: Henderson et al: ABO-incompatible heart transplantation: analysis of the Pediatric Heart Transplant Study (PHTS) database.
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