GOSH and UCL ICS: Donor Heart Transplant Method with Blood Group Incompatibility

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2021: Development of a technique for heart transplantation with incompatibility of blood group

On October 22, 2021, it became known that Britain they had developed a method for a heart transplant with incompatibility of the blood type.

As reported, twice as many children will get a chance for change hearts thanks to the methodology developed by clinic specialists Great Ormond Street (GOSH) University College London Institute for Cardiovascular Research (UCL ICS) financial and with the support of the British Heart Foundation (BHF). The protocol is already being applied at Great Ormond Street Clinic.

As of October 2021, about 50 children in the UK need a heart transplant, but the donor organ must match in size, which complicates the search. Children and infants who require emergency surgery spend an average of about 88 days in line, which is more than two times more than the emergency waiting period in adults - 35 days. If the case is considered non-urgent, then it usually takes more than a year to wait.

Over the past 20 years, heart transplantation operations have become more accessible to children, as it has become possible to transplant it from a donor with another blood type. In order to avoid rejection, the child's blood is completely removed and replaced by the blood of the same group as the heart donor. For transfusion, three times the volume of blood is required, so a transplant of an "inappropriate" heart was previously available only for very young children - not heavier than 15 kg and/or no older than 4 years.

A combined team of researchers from GOSH and UCL ICS led by Dr. Richard Issith found a method that significantly reduces the need for donor blood when transplanting an "inappropriate" heart. It consists in the use of a special blood filter - the so-called immunoadsorption column. During a heart transplant, this filter removes inappropriate antibodies that can lead to organ rejection and moves them to the artificial heart-lung apparatus, which provides oxygen and nutrients until the end of the operation. Filtration of specific antibodies allows not to replace the child's blood completely, so donor blood during surgery and during intensive care after it requires half as much. As a result, a transplant of an "inappropriate" heart has become available for older children and more weight, which means that a suitable donor organ can be found faster.

The team led by Dr. Issita has already performed 10 operations to transplant "non-conforming" hearts using an immunoadsorption column and compared their results with the result of 27 operations performed using a standard technique - that is, with complete removal and replacement of blood. All children who underwent an antibody filter transplant remained alive, while there was no need for re-transplantation. In the hospital, they spent as much time as children who underwent a transplant according to the standard methodology. The oldest of these ten children at the time of the operation was 8 years old - twice as much as the oldest child who received a donor organ according to the standard scheme.

Richard Issit

Dr. Issit and colleagues are continuing their research to help children with a particularly sensitive immune system. It is almost impossible to find a suitable donor heart for them, but the development gives them the hope of the transplant they need.

Not all children were lucky enough to be born with a completely healthy heart. Including an antibody filter in the current transplant protocol is a simple step, but it gives small patients a chance to get a new heart. narrated by Dr. Richard Issit, Senior Pediatric Perfusiologist at Great Ormond Street Clinic and Head of the GOSH and UCL ICS Research Group under the patronage of the British Heart Foundation

No child should spend the first years of his life waiting for a heart transplant. Building on the results of this study, we will continue to look for new ways that will make life-saving heart transplants available to even more children. added Sir Nilesh Samani, Professor, Medical Director, British Heart Foundation

The results of the study, for which the British Heart Foundation allocated £390 000 to Dr. Richard Issith, were published in the Journal of Heart and Lung Transplantation. Earlier, Richard Issith was awarded another grant in the amount of about £27 000 from the charity fund of Great Ormond Street Children's Hospital: these funds allowed for initial laboratory testing, which led to the introduction of this technique into clinical practice.