title: Impact of ABO compatibility on outcomes after heart transplantation in a national cohort during the past decade.
abstract: BACKGROUND
  Immunologic incompatibility has implications for primary graft failure, rejection, and survival in heart transplantation. To our knowledge, this is the first large cohort study investigating the impact of ABO-compatible versus identical blood type matching on post heart transplantation survival.
  
  
  METHODS
  We used a nationwide sample (2000-2010) within the United Network for Organ Sharing database. Stratification was between ABO-identical and ABO-compatible heart transplantations for univariate and multivariate analyses. The primary end point was graft failure from all causes. Posttransplant survival was compared between groups using Cox proportional hazard and logistic regression models.
  
  
  RESULTS
  A total of 17,951 patients met inclusion criteria, and 2684 (approximately 15%) underwent ABO-compatible heart transplantation. ABO-compatible recipients were generally sicker than ABO-identical recipients before transplant because more were status 1A, in the intensive care unit, and receiving mechanical ventilatory support (P < .05). Univariate analysis correlated ABO-compatible transplants with decreased posttransplant survival and a higher incidence of primary graft failure as cause of death (P < .05). There was no significant difference in acute graft rejection (P = .53). Multivariate analysis, however, did not demonstrate adverse outcomes in terms of decreased graft survival (hazard ratio, 0.99; P = .87). Blood type O donor grafts were associated with poorer outcomes compared with all other types (P < .05).
  
  
  CONCLUSIONS
  ABO-compatible transplantation does not result in adverse outcomes with respect to graft survival. Blood type O donor grafts, however, were associated with decreased survival. This has important implications for current graft allocation policies, particularly for type B recipients.
authors: Bonde Artificial Heart and Heart Transplantation Laboratory, New Haven, Conn.
authors: Oliver K
authors: OK
authors: Jawitz
authors: Nicole
authors: N
authors: G Jawitz
authors: David D
authors: DD
authors: Yuh
authors: Pramod
authors: P
authors: Bonde
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility / Q000150:complications / Q000276:immunology* / Q000401:mortality; D001788:Blood Grouping and Crossmatching; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System
keywords: 34; ECMO; HLA; ICU; UNOS; United Network for Organ Sharing; extracorporeal membrane oxygenation; human leukocyte antigen; intensive care unit