Impact of ABO-incompatible listing on wait-list outcomes among infants listed for heart transplantation in the United States: a propensity analysis.

Abstract

BACKGROUND:

The purported advantage of ABO-incompatible (ABO-I) listing is to reduce wait times and wait-list mortality among infants awaiting heart transplantation. We sought to describe recent trends in ABO-I listing for US infants and to determine the impact of ABO-I listing on wait times and wait-list mortality.

METHODS AND RESULTS:

In this multicenter retrospective cohort study using Organ Procurement and Transplant Network data, infants<12 months of age listed for heart transplantation between 1999 and 2008 (n=1331) were analyzed. Infants listed for an ABO-I transplant were compared with a propensity score-matched cohort listed for an ABO-compatible transplant through the use of a Cox shared-frailty model. The primary end point was time to heart transplantation. The percentage of eligible infants listed for an ABO-I heart increased from 0% before 2002 to 53% in 2007 (P<0.001 for trend). Compared with infants listed exclusively for an ABO-compatible heart, infants with a primary ABO-I listing strategy (n=235) were more likely to be listed 1A, to have congenital heart disease and renal failure, and to require extracorporeal membrane oxygenation. For the propensity score-matched groups (n=197 matched pairs), there was no difference in wait-list mortality; however, infants with blood type O assigned an ABO-I listing strategy were more likely to undergo heart transplantation by 30 days (31% versus 16%; P=0.007) with a less pronounced effect for infants with other blood types.

CONCLUSIONS:

The proportion of US infants listed for an ABO-I heart transplantation has risen dramatically in recent years but still appears to be preferentially used for sicker infant candidates. The ABO-I listing strategy is associated with a higher likelihood of transplantation within 30 days for infants with blood group O and may benefit a broader range of transplantation candidates.

• Authors: Christopher S Almond, Kimberlee Gauvreau, Ravi R Thiagarajan, Gary E Piercey, Elizabeth D Blume, Leslie B Smoot, Francis Fynn-Thompson, Tajinder P Singh
• Journal: Circulation (Circulation) Vol. 121 Issue 17 Pg. 1926-33 (May 04 2010) ISSN: 1524-4539 [Electronic] United States
• PMID: 20404257 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Chemical References

• ABO Blood-Group System

Topics

• ABO Blood-Group System (immunology)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Heart Failure (immunology, mortality, surgery)
• Heart Transplantation (immunology, mortality)
• Histocompatibility (immunology)
• Humans
• Infant
• Infant, Newborn
• Male
• Proportional Hazards Models
• Retrospective Studies
• Tissue Donors (supply & distribution)
• Tissue and Organ Procurement (statistics & numerical data)
• United States (epidemiology)
• Waiting Lists