Page 12 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

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extended outside the infant age range and to sensitized patients although OPTN restrictions some of
these practices.

Table 1
Recipient Compatible donor Incompatible
O O A, B, AB
A A, O B, AB
B B, O A, AB
AB AB, B, A, O ---

Criteria for Suitable Recipient:
No restriction on ABOi is placed by OPTN in infants (<12 months age). For children between 1 and 2
years of age OPTN allows ABOi transplant provided isohemagglutinin titers are ≤ 1:16. From the clinical
standpoint titers <1:64 can usually be safely crossed and even higher titers if consideration is given to
managing the potential antibody mediated rejection (AMR) by measures that may include rituximab
immediately pre-transplant, plasmapheresis and eculizumab.

Pre-Transplant Protocols:
Isohemagglutinin Assessment
Assess isohemagglutinin titers (anti-A and anti-B antibodies) in those considered for an ABOi transplant.
Check at time of listing for status 1A/1B and re-check monthly during waiting period (OPTN
requirement). Repeat when a potential ABO-incompatible donor becomes available.

Blood Products While Listed
For patients who may be suitable for an ABOi transplant in the future and require blood products then
the following guide (Table 2) regarding transfusion blood group products should be followed:

Table 2 Transfusion Products
1 2
Recipient RBCs FFP, Platelets or Cryoprecipitate

Group O O AB

Group A A or O AB

Group B B or O AB

1. If there is insufficient availability of group AB platelets, group B or A platelets can be used if saline-washed
and concentrated to remove excess antibody (Lori West, Alberta protocol Jan 2006).
2. Any blood type can be given if necessary but preference is given to AB.

Peri-Transplant Protocols:
With Pre-operative labs, obtain isohemagglutinin titers

Updated November 9, 2017 12