Page 13 - Heart Transplant Guidelines
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Heart Function Service: Heart Transplant Guidelines

               Intra-operative Testing
               A sample is sent following plasma exchange. Blood bank should provide a rapid response:

                   •  If titers are ≤1:4 no further action required.
                   •  If titers are >1:4 further plasma exchanges should be followed by repeat isohemagglutinin
                       testing until titers are ≤1:4 before cross-clamp removal.

               Blood product for priming CPB Circuit and for Patient Administration
               Care must be taken to give appropriate blood products to avoid a transfusion reaction or damage to the
               graft. Compatible products are detailed in Table 3.

               Table 3 (Adapted from West et al., 2001)

                     Recipient                    RBCs          FFP, Platelets  or Cryoprecipitate
                     Group O (donor A, B, AB)     O             AB or Donor type
                     Group A (donor B, AB)        A or O        AB

                     Group B (donor A, AB         B or O        AB

                   1.  RBC group O (universal donor) can be given to any transplant recipient as the recipient will not have
                       antibodies against the RBCs and there is insufficient isohemagglutinin in the RBC transfusion to damage
                       the graft.
                   2.  If there is insufficient availability of group AB platelets, group B or A platelets can be used if saline-washed
                       and concentrated to remove excess antibody (Lori West, Alberta protocol Jan 2006).
                   3.  Any blood type can be given if necessary but preference is given to donor type or AB.
               Post-Transplant Guidelines:
               Precautions for Future Transfusions
               Recipients of ABO-incompatible grafts can never receive whole blood infusions. Any future surgeries,
               including emergencies, must be undertaken with appropriate preparation for possible transfusion needs
               utilizing Table 3 as the guide.

               IVIG preparations do not contain significant quantities of antibodies to blood group antigens and can be
               administered safely to ABOi graft recipients.

               Post-Operative Immunosuppression
               Routine immunosuppression is given as per compatible ABO transplants.

               Routine Post Transplant Isohemagglutinin Assessment
                   •  Daily for  10 days post-transplant, unless clinically warranted to extend
                   •  Weekly until one month post-transplant
                   •  Every 2 weeks until 3 months post-transplant
                   •  Monthly until 6 months post-transplant

               Updated December 14, 2018                                                                   13
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