A new technique developed by researchers we funded at the Great Ormond Street Hospital for Children has doubled the number of children who can receive heart transplants, giving them new hope for a longer, healthier life.
Right now, around 50 children are waiting for a heart transplant in the UK, but small hearts are hard to find as the donated heart must be from a child of about the same size. The agonizing wait to know if a suitable heart is available for an urgent transplant is more than twice as long for children and babies – an average wait of 88 days compared to 35 days for an adult, while children judged “no” urgent âwill wait over a year on average.
Over the past 20 years, doctors have increased the number of organs available to children in need of heart transplants by using âABO-incompatibleâ donor hearts, where the donated heart does not have the same group. blood as the child receiving the transplant.
However, to ensure that the âincompatibleâ heart is not rejected, the child’s blood is drawn and their circulation is âcleansedâ with a blood group that matches the donated heart. This requires three times more new blood than new blood, which limits this type of heart transplant to small children weighing up to around 15 kg or as young as four years old.
Allowing older children to have a transplant
Today, Dr Richard Issitt and his team at GOSH have found a way to use a special blood filtration device – called an immunoadsorption column – during the transplant operation to reduce the amount of blood needed and allow older children to receive the transplant they desperately need.
The device removes unpaired antibodies from the blood that can lead to transplant rejection and is added to the heart and artificial lung used to support the child during surgery. This machine keeps their blood flowing, delivering oxygen and essential nutrients throughout their body until the new heart is in place.
By filtering out specific antibodies, the child’s blood does not need to be completely removed and replaced. This therefore halves the amount of donated blood needed during the transplant itself and in the intensive care unit afterwards, allowing older and older children to have an ‘incompatible’ transplant, which makes them feel better. makes it more likely to be matched with a suitable heart.
Lucy, 10, from Basingstoke, is the oldest known person in the world who may have had a transplant to receive a âmismatchâ heart.
Learn more about Lucy’s story.
The team has now performed ABO-incompatible heart transplant with the new antibody filtering device on 10 children, and compared their results to 27 children who had the standard ABO-incompatible heart transplant technique, where all blood has been removed and replaced.
All of the children who had a transplant using the new device survived, there was no need for re-transplantation and there was no difference in the length of hospital stay. The oldest child to receive a transplant using this technique was eight years old, double the age of the oldest child previously treated.
A transformational gift
They are now exploring ways to allow children with strong immune systems – making it nearly impossible to find a suitable heart – to have the chance to receive a transplant they desperately need.
Dr Richard Issitt, BHF-funded researcher and senior pediatric perfusionist at Great Ormond Street Hospital, who led the study, said:
âSome children and babies don’t have the luxury of having a fully functioning heart. Just incorporating this new device into the current transplant procedure means we can increase the chances of giving them the transformational gift of a new heart.
âNo child should start their first years of life impatiently awaiting a heart transplant. We are determined to use this research to find new ways that will allow more children to have life-saving heart transplants.
Give hope to more children
Our Medical Director Professor Sir Nilesh Samani said:
âThis is a major breakthrough in pediatric heart transplantation, which gives hope to more children who desperately need a new heart to survive.
âLess than 60 years ago, heart transplantation was considered an impossible dream. Since then, research has turned that dream into reality for thousands of people across the UK. “
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