Materials: A Female patient, 16 months old, 7.8 Kg weight, blood group B (-), was admitted at the cardiovascular ICU in December 2003, with a dilated cardiomiopathy (post-viral). After 25 days on waiting list, she was supported with assisted mechanical ventilation, i.v. inotropic drugs and peritoneal dialysis, she underwent transplantation with an AB (+) organ. The female donor was 17 months old and weighted 12 Kg.

Methods: West Protocol for ABO incompatible donors was slightly modified according to our patient who had high levels isohaemagglutinin. Standard surgery technique was used, with cava-cava anastomosis. By-pass 28 C. Aprotinin and hemofiltration
During cardiopulmonary by-pass, three times the total blood was exchanged, oxigenator were changed too. Plasma AB and red cells B (+) were used for replacement. Aprotinin and hemofiltration was used.
Results: The immediate course was uneventful. Dopamine and Milrinone was used. Extubated four days later. Gal, azathioprine, cyclosporine and steroids were used. She was discharged 19 days after transplantation. Haemagglutinins titers were 1 to 1/4.
Follow up: 5 years follow up show hemodinamically good condition, without steroid requirements. Haemaglutinins titers remain similar. NYHA: Class 1. DDLV, SDLV were normal. Cath: normal coronary arteries, and no rejection signs in biopsy. Now she received Mycophenolate and low doses cyclosporine.
Conclusion: hearts donors is a problem worldwide.
This patient’s evolution supports the idea that ABO incompatible heart transplantation may be performed safely in some children beyond the West protocol age.
This technique thus contributes to reduce mortality among infants on the heart waiting list.