Page 14 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

IVIG preparations do not contain significant quantities of antibodies to blood group antigens and can be
administered safely to ABOi graft recipients.

Post-Operative Immunosuppression
Routine immunosuppression is given as per compatible ABO transplants.

Routine Post Transplant Isohemagglutinin Assessment
 Daily for 10 days post-transplant, unless clinically warranted to extend
 Weekly until one month post-transplant
 Every 2 weeks until 3 months post-transplant
 Monthly until 6 months post-transplant
 Every 3 months until 1 year post-transplant
 Annually

Management of Rising Isohemagglutinins against the Graft:
Note that if a significant rise is seen in the postoperative period then a repeat later that day is
appropriate as sometimes if a secondary immune response is occurring it can be very rapid.
An urgent echo should be undertaken to establish graft function. If function poor and the titers are
significantly raised then consideration should be given to eculizumab or initiating plasmapheresis.
Rituximab may be required.

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If the incompatibility becomes a problem it usually arises around the 4 postoperative day and if severe
may last a month or so but usually settles within a week with appropriate treatment.

Management of rising Isohemagglutinin titers:

 <1:16 – Repeat titers next day
 1:16 – Evaluate allograft function (echo, exam, end-organ labs)
 1:32 – Consider treatment with Rituximab 375 mg/m2
 >1:32 – Rituximab 375 mg/m2 and consider plasmapheresis +/-Bortezomib if change in clinical
stability

Breastfeeding for Potential ABO-Incompatible Recipients
Breastfeeding is not a contraindicated for infants pre or post-transplant.

References

1. West LJ, Pollock-Barziv SM, Dipchand AI, et al. ABO-incompatible heart transplantation in
infants. N Engl J Med. 2001;344(11):793-800. doi:10.1056/NEJM200103153441102.
2. Urschel S, Larsen IM, Kirk R, et al. ABO-incompatible heart transplantation in early childhood: an
international multicenter study of clinical experiences and limits. JHLT. 2013;32(3):285-292.
doi:10.1016/j.healun.2012.11.022.
3. Irving C, Gennery A, Kirk R. Pushing the boundaries: The current status of ABO-incompatible
cardiac transplantation. JHLT. 2012;31(8):791-796. doi:10.1016/j.healun.2012.03.007.
4. Winters J, King K, eds. Therapeutic Aphereis: A Physicians Handbook. 4th ed. AABB/ASFA; 2013.

Updated November 9, 2017 14