Use of plasmapheresis during cardiopulmonary bypass in a pediatric heart transplant of a patient with Failing Fontan Physiology: first case in Argentina

TL;DR

A 17-year-old patient with a failing heart underwent a successful heart transplant in Argentina using plasmapheresis during surgery to reduce rejection risk.

Contribution

This is the first reported case in Argentina using plasmapheresis during cardiopulmonary bypass for a sensitized pediatric heart transplant patient.

Findings

Plasmapheresis during surgery reduced panel-reactive antibodies to 0% by the tenth postoperative day.

No evidence of immunological or humoral rejection was observed in follow-up biopsies.

The patient remains rejection-free three years post-transplant.

Abstract

Background: A 17-year-old male patient diagnosed with a single ventricle, in a failed Fontan stage, was evaluated prior to heart transplantation. The patient had a panel-reactive antibody (PRA) for human leucocyte antigen (HLA) I of 18% and for HLA II of 37%, so the decision was made to administer three doses of immunoglobulin while waiting for a donor heart. Methods: Once extracorporeal circulation was initiated, the apheresis machine extracted blood from the patient’s venous drainage and returned it to the oxygenator reservoir. A total of 8278 mL of blood was processed, and 4224 mL of plasma was extracted. For replacement, 1341 mL of fresh frozen plasma and 2700 mL of 5% albumin were used. 75 mL of citrate-dextrose acid (CDA) was used as an anticoagulant. The procedure lasted 135 min. Results: On the tenth postoperative day, the PRA for HLA I and II was 0%. On the thirtieth postoperative day, a catheterization with endomyocardial biopsy showed no evidence of immunological rejection. An echocardiogram showed good function of the heart graft. One year later, a catheterization with endomyocardial biopsy showed no signs of humoral rejection. The patient is currently in the third-year post-transplant and continues to show no signs of rejection in their progression. Conclusion: Plasmapheresis during cardiopulmonary bypass is a reproducible, safe, and effective technique. It may be indicated for sensitized patients on the heart transplant waiting list.

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