J Extra Corpor Technol 2026, 58, 79--84 Ó The Author( s), published by EDP Sciences, 2026 https:// doi. org / 10.1051 / ject / 2025053
Available online at: ject. edpsciences. org
CASE REPORT
Use of plasmapheresis during cardiopulmonary bypass in a pediatric heart transplant of a patient with Failing Fontan Physiology: first case in Argentina
Matias Jorge Martinez( Perfusionist) 1,*, Ignacio Berra( MD) 1, Javier Cornelis( MD) 1, Juan Costilla( Perfusionist) 1, Fernando Zamora( MD) 2, and Pablo Garcia Delucis( MD) 1
1 Cardiovascular Surgery, Heart Transplant and Peripheral Vascular Service. Prof. Dr. Juan P. Garrahan Pediatric Hospital, Combate de los Pozos 1881( 1245), CABA, Buenos Aires, Argentina 2 Hemotherapy and Transfusion Medicine Service. Prof. Dr. Juan P. Garrahan Pediatric Hospital, Combate de los Pozos 1881( 1245),
CABA, Buenos Aires, Argentina Received 21 March 2025, Accepted 11 September 2025
Abstract – Background: A 17-year-old male patient diagnosed with a single ventricle, in a failed Fontan stage, was evaluated prior to heart transplantation. The patient had a panel-reactive antibody( PRA) for human leucocyte antigen( HLA) I of 18 % and for HLA II of 37 %, so the decision was made to administer three doses of immunoglobulin while waiting for a donor heart. Methods: Once extracorporeal circulation was initiated, the apheresis machine extracted blood from the patient’ s venous drainage and returned it to the oxygenator reservoir. A total of 8278 mL of blood was processed, and 4224 mL of plasma was extracted. For replacement, 1341 mL of fresh frozen plasma and 2700 mL of 5 % albumin were used. 75 mL of citrate-dextrose acid( CDA) was used as an anticoagulant. The procedure lasted 135 min. Results: On the tenth postoperative day, the PRA for HLA I and II was 0 %. On the thirtieth postoperative day, a catheterization with endomyocardial biopsy showed no evidence of immunological rejection. An echocardiogram showed good function of the heart graft. One year later, a catheterization with endomyocardial biopsy showed no signs of humoral rejection. The patient is currently in the third-year post-transplant and continues to show no signs of rejection in their progression. Conclusion: Plasmapheresis during cardiopulmonary bypass is a reproducible, safe, and effective technique. It may be indicated for sensitized patients on the heart transplant waiting list.
Key words: HLA, Antibodies, Heart transplant, Plasmapheresis, Cardiopulmonary bypass.
Introduction HLA and therapeutic plasma exchange
The human leukocyte antigens( HLA) system includes a complex variety of genes located within the Major histocompatibility complex( MHC) on the short arm of chromosome 6, along with their molecular products, which are involved in immune regulation and cellular differentiation. HLA molecules are expressed on nearly all nucleated cells and are the primary molecules that initiate graft rejection. HLA antigens are divided into two groups( Class I and Class II). The HLA-A, HLA-B, and HLA-C genes encode the corresponding Class I antigens A, B, and C. The HLA-DR, HLA-DQ, and HLA-DP genetic groups encode the synthesis of the Class II antigens with the same names. Class I molecules are found on the surface of platelets and most nucleated cells in the body. Class II antigens are
* Corresponding author: matiasperfusion @ gmail. com limited to a few cell types, such as B lymphocytes, monocytes, macrophages, dendritic cells, and activated T lymphocytes [ 1 ].
When a human transplant is performed, the HLA molecules of a donor are recognized by the immune system of the recipient through direct and indirect allo-recognition methods that trigger an alloimmune response. The compatibility between the donor and recipient for MHC antigens has a significant positive effect on graft acceptance. In organ transplantation, adaptive immunity is the primary response to the transplanted tissue, as the main target of the immune response is the MHC molecules expressed on the surface of the donor’ s cells. Activation of T cells leads to the production of cytokines and chemokines, which in turn can recruit components of innate immunity such as NK cells, macrophages, and the complement system. Additionally, defensins and cathelicidins have chemotactic properties on T lymphocytes.
In transplant immunology, the greatest impact on graft loss comes from the effects of HLA-B and-DR antigens. The effects of HLA-DR mismatches are most significant in the first
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