eprintid: 10130842 rev_number: 17 eprint_status: archive userid: 608 dir: disk0/10/13/08/42 datestamp: 2021-07-07 12:51:08 lastmod: 2022-09-04 10:29:52 status_changed: 2021-07-07 12:51:08 type: article metadata_visibility: show creators_name: Issitt, R creators_name: Booth, J creators_name: Crook, R creators_name: Robertson, A creators_name: Molyneux, V creators_name: Richardson, R creators_name: Cross, N creators_name: Shaw, M creators_name: Tsang, V creators_name: Muthurangu, V creators_name: Sebire, NJ creators_name: Burch, M creators_name: Fenton, M title: Intraoperative anti-A/B immunoadsorption is associated with significantly reduced blood product utilization with similar outcomes in pediatric ABO-incompatible heart transplantation ispublished: inpress subjects: GOSH divisions: UCL divisions: B02 divisions: D14 divisions: GA1 divisions: D13 divisions: G25 keywords: cardiopulmonary bypass, heart transplantation, immunoadsorption, pediatrics note: Copyright 2021 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) abstract: BACKGROUND: Intraoperative anti-A/B immunoadsorption (ABO-IA) was recently introduced for ABO-incompatible heart transplantation. Here we report the first case series of patients transplanted with ABO-IA, and compare outcomes with those undergoing plasma exchange facilitated ABO-incompatible heart transplantation (ABO-PE). METHODS: Data were retrospectively analysed on all ABO-incompatible heart transplants undertaken at a single centre between January 1, 2000 and June 1, 2020. Data included all routine laboratory tests, demographics and pre-operative characteristics, intraoperative details and post-operative outcomes. Primary outcome measures were volume of blood product transfusions, maximum post-transplant isohaemagglutinin titres, occurrence of rejection and graft survival. Secondary outcome measures were length of intensive care and hospital stay. Demographic and survival data were also obtained for ABO-compatible transplants during the same time period for comparison. RESULTS: Thirty-seven patients underwent ABO-incompatible heart transplantation, with 27 (73%) using ABO-PE and 10 (27%) using ABO-IA. ABO-IA patients were significantly older than ABO-PE patients (p < 0.001) and the total volume of blood products transfused during the hospital admission was significantly lower (164 [126-212] ml/kg vs 323 [268-379] ml/kg, p < 0.001). No significant differences were noted between methods in either pre or post-transplant maximum isohaemagglutinin titres, incidence of rejection, length of intensive care or total hospital stay. Survival comparison showed no significant difference between antibody reduction methods, or indeed ABO-compatible transplants (p = 0.6). CONCLUSIONS: This novel technique appears to allow a significantly older population than typical to undergo ABO-incompatible heart transplantation, as well as significantly reducing blood product utilization. Furthermore, intraoperative anti-A/B immunoadsorption does not demonstrate increased early post-transplant isohaemagglutinin accumulation or rates of rejection compared to ABO-PE. Early survival is equivalent between ABO-IA, ABO-PE and ABO-compatible heart transplantation. date: 2021-05-29 date_type: published official_url: https://doi.org/10.1016/j.healun.2021.05.010 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1874724 doi: 10.1016/j.healun.2021.05.010 pii: S1053-2498(21)02325-1 lyricists_name: Issitt, Richard lyricists_name: Muthurangu, Vivek lyricists_name: Sebire, Neil lyricists_name: Tsang, Victor lyricists_id: RWIIS56 lyricists_id: VMUTH99 lyricists_id: NJSEB45 lyricists_id: TVICT74 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: The Journal of Heart and Lung Transplantation event_location: United States citation: Issitt, R; Booth, J; Crook, R; Robertson, A; Molyneux, V; Richardson, R; Cross, N; ... Fenton, M; + view all <#> Issitt, R; Booth, J; Crook, R; Robertson, A; Molyneux, V; Richardson, R; Cross, N; Shaw, M; Tsang, V; Muthurangu, V; Sebire, NJ; Burch, M; Fenton, M; - view fewer <#> (2021) Intraoperative anti-A/B immunoadsorption is associated with significantly reduced blood product utilization with similar outcomes in pediatric ABO-incompatible heart transplantation. The Journal of Heart and Lung Transplantation 10.1016/j.healun.2021.05.010 <https://doi.org/10.1016/j.healun.2021.05.010>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10130842/1/1-s2.0-S1053249821023251-main.pdf