title: Outcomes after ABO-incompatible heart transplantation in adults: A registry study.
abstract: BACKGROUND
  In the past, ABO incompatibility was considered an absolute contraindication to heart transplantation (HT) in adults. Advances in ABO-incompatible HT in pediatric patients and ABO-incompatible abdominal transplantation in adult patients have led to clinical exploration of intentional ABO-incompatible HT in adults. However, it is not well known how outcomes in ABO-incompatible adult heart transplant recipients compare with outcomes in ABO-compatible recipients.
  
  
  METHODS
  We analyzed International Society for Heart and Lung Transplantation transplant registry data from heart donors and recipients ≥18 years old at the time of transplant for HT performed between 1988 and 2011. We compared baseline characteristics and post-transplant outcomes in ABO-incompatible and ABO-compatible HT. Death or retransplantation was the composite primary end-point.
  
  
  RESULTS
  Among 76,663 adult patients undergoing HT between 1988 and June 30, 2011, 94 ABO-incompatible heart transplants were performed. The incidence of death or retransplantation in the ABO-incompatible group was higher than in the ABO-compatible group: 21% vs 9% at 30 days (hazard ratio = 2.38, p < 0.001) and 36% vs 19% at 1 year after transplant. However, ABO-incompatible grafts surviving past the first year after transplant had a similar incidence of failure compared with the ABO-compatible group. After 2005, the rate ABO-incompatible HT in adults increased, likely as a result of planned, intentional (rather than accidental) ABO-incompatible HT. In this group of patients, short-term and long-term incidence of death or retransplantation was similar to ABO-compatible recipients (p = 0.822): 7% at 30 days and 19% at 1 year after transplantation.
  
  
  CONCLUSIONS
  We found no difference in incidence of death or retransplantation between ABO-compatible and ABO-incompatible HT in patients who underwent transplantation after 2005.
authors.affiliation: Department of Clinical Sciences Lund, Cardiothoracic Surgery.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bergenfeldt
authors.affiliation: Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Andersson
authors.affiliation: Department of Clinical Sciences Malmö, Surgery, Transplantation Unit, Lund University and Skåne University Hospital, Malmö, Sweden.
authors.forename: Dragan
authors.initials: D
authors.lastname: Bućin
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, School of Medicine Salt Lake City, Utah; The ISHLT International Registry for Heart and Lung Transplantation, Dallas, Texas.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: The ISHLT International Registry for Heart and Lung Transplantation, Dallas, Texas.
authors.forename: Leah
authors.initials: L
authors.lastname: Edwards
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Rådegran
authors.affiliation: Department of Clinical Sciences Lund, Cardiothoracic Surgery. Electronic address: johan.nilsson@med.lu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility / Q000453:epidemiology / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System
keywords: ABO; blood group incompatible heart transplant; heart transplantation