Successful management of a B-type cardiac allograft into an O-type man with 3 1/2-year clinical follow-up

Background. In May 1997, a 19-year-old male patient of histo-blood group ty pe O suffering from congenital end-stage heart failure accidentally receive d a cardiac allograft of type B and is still alive in fair condition. Methods. In addition to conventional immunosuppressive therapy, plasma exch ange (PEX), extracorporeal immunoabsorption (EIA), intravenous immunoglobul ins (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 accommodati on without obvious signs of rejection. The patient has been surviving for 4 2 months; retransplantation with an O-type heart remained unnecessary. Conclusion. Humoral rejection has been avoided in this patient, with PEX, E IA, IVIG, and C1 inhibitor substantially contributing to this success. With future availability of such combined therapies, preferably before transpla ntation, vascular rejection events caused by preformed antibodies and compl ement (ABO mismatch or anti-HLA) could be prevented or treated.