Page 13 - Heart Transplant Protocol
P. 13

Heart Function Service: Heart Transplant Protocols

               If significant isohemagglutinin titers against the donor heart (titers ≥ 1:4) are present plasma exchange
               should be undertaken prior to cross clamp release until titers ≤ 1:4 are achieved.

               Plasma Exchange
               Plasma exchange is performed via CPB circuit immediately after instituting CPB by withdrawing whole
               blood and infusing recipient-type RBCs reconstituted with plasma of the appropriate blood group (Table
               3). Cell saver equipment can be used. The number of plasma volumes required will depend upon the
               initial isohemagglutinin titer. For titers 1:16 or less a 1.5 volume exchange should theoretically remove
               78% of isohemagglutinins. Higher titers may require a 2 volume exchange which should remove up to
                                      4
               86% of isohemagglutinins .
               Assessment of isohemagglutinins should be done after plasma exchange to ensure that antibody
               removal has been accomplished (< 1:4 is acceptable).
               Intra-operative Testing
               A sample is sent following plasma exchange. Blood bank should provide a rapid response:

                     If titers are ≤1:4 no further action required.
                     If titers are >1:4 further plasma exchanges should be followed by repeat isohemagglutinin
                       testing until titers are ≤1:4 before cross-clamp removal.
               Blood product for priming CPB Circuit and for Patient Administration

               Care must be taken to give appropriate blood products to avoid a transfusion reaction or damage to the
               graft. Compatible products are detailed in Table 3.

               Table 3 (Adapted from West et al., 2001)

                                                                                              3
                                                                             2
                                                       1
                     Recipient                    RBCs          FFP, Platelets  or Cryoprecipitate
                     Group O (donor A, B, AB)     O             AB or Donor type

                     Group A (donor B, AB)        A or O        AB


                     Group B (donor A, AB         B or O        AB


                   1.  RBC group O (universal donor) can be given to any transplant recipient as the recipient will not have
                       antibodies against the RBCs and there is insufficient isohemagglutinin in the RBC transfusion to damage
                       the graft.
                   2.  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).
                   3.  Any blood type can be given if necessary but preference is given to donor type or AB.

               Post-Transplant Protocols:
               Precautions for Future Transfusions
               Recipients of ABO-incompatible grafts can never receive whole blood infusions. Any future surgeries,
               including emergencies, must be undertaken with appropriate preparation for possible transfusion needs
               utilizing Table 3 as the guide.








               Updated November 9, 2017                                                                    13
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