INTRODUCTIONDuring infancy, humoral rejection of a cardiac allograft has not been reported in the absence of risk factors. We report an infant with dilated cardiomyopathy who developed multiple episodes of acute humoral rejection after heart transplantation in the absence of risk factors such as prior transplantation, blood transfusions, ventricular assist devices, and elevation of panel reactive antibodies. We had parental permission as well as approval by the Institutional Review Board to study all patients undergoing heart transplantation at our institution.PATIENT PROFILEA 4‐month‐old previously healthy male presented with heart failure symptoms. An echocardiogram revealed severely depressed left ventricular (LV) function (ejection fraction of 8%), moderate pericardial effusion, and severe LV dilation. He was placed on milrinone and furosemide infusions and was diagnosed with a dilated cardiomyopathy, and listed for cardiac transplantation. He had never received a blood transfusion prior to his transplant. Pretransplant panel reactive antibodies I and II were 0%, at the age of 4 months and the night before transplant. At the age of 7 months, he underwent an ABO‐compatible (O+/O+), cytomegalovirus‐ and Epstein‐Barr virus‐mismatched (CMV+/−, EBV+/−) bicaval heart transplant. The prospective donor‐specific crossmatch was negative. The surgery was uneventful with an allograft ischemic time of 104 min. The
Journal of Cardiac Surgery – Wiley
Published: Jan 1, 2018
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