Surgeons Perform ABO-Incompatible Heart Transplant on an 11-Month-Old in Shanghai

The end-stage heart failure team at Shanghai Children's Medical Center has successfully performed an ABO-incompatible heart transplant on an 11-month-old infant weighing just 8 kilograms with restrictive cardiomyopathy, breaking the blood-type matching constraint of conventional organ transplantation. The child, known by the pseudonym Xixi, developed sudden generalized edema and was diagnosed with a rare restrictive cardiomyopathy; after two weeks of standard anti-heart-failure treatment, cardiac function showed no improvement. The donor heart allocated through the national organ allocation system was type B while the child was type A — ABO incompatibility is regarded as an absolute contraindication in conventional transplantation.

Exploiting the "golden window" of an immature immune system in infants under 2, the team performed two consecutive preoperative plasma exchanges to remove specific antibodies, completed donor heart implantation and vascular anastomosis under cardiopulmonary bypass, and applied a precise immunosuppressive regimen afterwards. The child has been weaned off the ventilator, with stable circulatory parameters and the ability to feed independently. Zhu Zhongqun, director of thoracic surgery, said the approach expands the pool of pediatric heart donors.