Human ABO blood group is important in survival and function of porcine working hearts

Abstract

Pig organs express αGal antigen and thus are hyperacutely rejected if perfused by human blood. Human B/A antigens are similar to pig αGal antigen, suggesting that the corresponding antibodies may cross-react. Our purpose was to determine if there is a human ABO blood-group difference in porcine-human xenotransplantation. Plasma from six A, five B, seven AB, and six O individuals pooled by blood group were tested in an ex-vivo porcine working heart model. Blood-group A plasma-perfused hearts survived 20 ± 14 min (n = 5), B 241 ± 9 min (n = 3), AB 151 ± 37 min (n = 5), and O 9 ± 1 min (n = 8). A and O were different (p < 0.001) from B and AB. Function was significantly better in group B. Edema accumulation and creatine kinase change was highest in A and O. All groups had comparable levels of anti-αGal antibody, as well as comparable perfusion and operative conditions. Multivariate linear regression analysis showed the anti-B antibody levels to be predictive of survival (p < 0.001). At higher plasma concentrations, hearts perfused with B plasma survived longer (p = 0.01) than AB (218 ± 45 min, n = 4 vs. 6 ± 0 min, n = 3). These results suggest a human ABO blood-group difference in porcine-to-human xenotransplantation, which may be mediated by the anti-A and anti-B antibodies.