Effect of ABO-incompatible listing on infant heart transplant waitlist outcomes: analysis of the United Network for Organ Sharing (UNOS) database.
BACKGROUND
Midterm heart transplant outcomes of ABO-incompatible (ABO-I) organ use in infants are favorable. ABO-I transplantation has resulted in reduced waitlist mortality in some countries. This study assessed the effect of an ABO-I listing strategy on pre-transplant outcomes in the United States.


METHODS
The Organ Procurement and Transplantation Network (OPTN)/United Network of Organ Sharing (UNOS) database was used to identify infants aged younger than 1 year listed as status 1 for heart transplantation between January 1, 2001, and May 20, 2008. The cohort was divided into 2 groups: eligible for ABO-compatible (ABO-C) transplant and eligible for ABO-I transplant. Baseline characteristics, waitlist times, and outcomes were compared in univariate analysis. Competing risks analysis evaluated differences in time to transplant in the presence of other outcomes.


RESULTS
Of 1,029 infants listed for transplant, 277 (27%) were listed for an ABO-I transplant. Overall, 92% of transplant recipients received an ABO-C organ regardless of listing type. Among recipients eligible for ABO-I, only 27% received an ABO-I organ. The percentage that underwent transplant in each group did not differ. Although infants listed for an ABO-I organ had a shorter wait time for transplant, waitlist mortality was similar.


CONCLUSIONS
Despite the intended merits of ABO-I heart transplantation, ABO-I listing and organ acceptance have not yielded lower waitlist mortality in the United States under the current UNOS allocation algorithm. Consideration should be given to altering the allocation system to one that gives less preference toward blood group compatibility in hopes of improving organ use and reducing waitlist mortality.
Everitt
Melanie D
MD
Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah, USA. melanie.everitt@imail.org
Donaldson
Amy E
AE
Casper
T Charles
TC
Stehlik
Josef
J
Hawkins
John A
JA
Tani
Lloyd Y
LY
Renlund
Dale G
DG
Kouretas
Peter C
PC
Kaza
Aditya K
AK
Bullock
Emily A
EA
Cardon
Michelle
M
Kfoury
Abdallah G
AG
D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility / Q000453:epidemiology*; D016208:Databases, Factual; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists
D000017:ABO Blood-Group System