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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

I Got It from My Mamma: Sensitization by Transplacental Transfer of Maternal HLA Antibodies Managed with Manual Exchange Transfusion

Published:January 23, 2023DOI:https://doi.org/10.1016/j.healun.2023.01.006
      A 3-week-old Amish boy with a homozygous MYBPC3 mutation causing severe cardiomyopathy admitted for refractory heart failure was referred for heart transplant evaluation. Due to the known risk of early mortality with this mutation
      • Zahka K
      • Kalidas K
      • Simpson MA
      • et al.
      Homozygous mutation of MYBPC3 associated with severe infantile hypertrophic cardiomyopathy at high frequency among the Amish.
      including a prior loss of another child in the family with the same phenotype, the infant was admitted to the hospital for management of heart failure and expedited evaluation. The patient was stabilized on intravenous milrinone. Labs were remarkable for high levels of Human Leukocyte Antigen (HLA) antibodies (Panel of Reactive Antibodies (PRA) Class I: 74%, Class II: 80%) with no known sensitizing events. Maternal history of multiple miscarriages raised the question whether his HLA antibodies may have resulted from maternal HLA sensitization with transplacental antibody transfer vs. active antibody production by the child
      • Savulescu DM
      • Groome M
      • Malfeld SCK
      • et al.
      HLA antibody repertoire in infants suggests selectivity in transplacental crossing.
      . Subsequent antibody testing of mother's blood and breast milk revealed nearly identical HLA antibody profiles to the patient. Due to the unclear role of antibodies transferred in the breastmilk and ongoing sensitization of the infant, it was recommended that the mother not breastfeed.

      Abbreviations:

      HLA (Human Leukocyte Antigens), PRA (Panel of Reactive Antibodies)
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