ABO-Incompatible Heart Transplantation in Infants: Analysis of the United Network for Organ Sharing Database

Nishant D. Patel, Eric S. Weiss, Janet Scheel, Duke E. Cameron, Luca Vricella

Research output: Contribution to journalArticle

Abstract

Introduction: ABO-incompatible heart transplantation, traditionally contraindicated because of the risk of hyperacute rejection, has been used selectively in recent years. Infants have limited production of isohemagglutinins, which may lower the risk of hyperacute rejection. A large national database was used to analyze the effect of ABO incompatibility on outcomes after heart transplantation in infants. Methods: Heart transplant recipients aged younger than 1 year reported to the United Network for Organ Sharing from 1999 to 2007 were divided according to donor-recipient ABO incompatibility or compatibility. Outcomes included Kaplan-Meier survival and hyperacute rejection. Propensity-adjusted Cox regression modeling was used to identify predictors of mortality. Results: Of 591 infants that underwent heart transplantation, 35 (6%) received allografts from ABO-incompatible donors. ABO-incompatible recipients trended toward more congenital heart disease (71% vs 66%; p = 0.06) and were less likely to have dilated cardiomyopathy (11% vs 29%; p = 0.02). One ABO-incompatible infant had hyperacute rejection requiring retransplantation. No ABO-incompatible infant and 2 ABO-compatible infants died from hyperacute rejection. Survival was similar at 3 years. Propensity-adjusted Cox regression analysis demonstrated that ABO-incompatibility did not predict mortality (hazard ratio, 3.61; 95% confidence interval, 0.26-49.0; p = 0.33). Conclusion: ABO-incompatible heart transplantation can be performed safely in infants without greater incidence of hyperacute rejection. ABO-incompatible heart transplantation should be strongly considered in infants to maximize donor organ utilization and reduce waiting-list mortality.

Original languageEnglish (US)
Pages (from-to)1085-1089
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume27
Issue number10
DOIs
StatePublished - Oct 2008

Fingerprint

Heart Transplantation
Databases
Tissue Donors
Mortality
Waiting Lists
Survival
Hemagglutinins
Dilated Cardiomyopathy
Allografts
Heart Diseases
Regression Analysis
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

ABO-Incompatible Heart Transplantation in Infants : Analysis of the United Network for Organ Sharing Database. / Patel, Nishant D.; Weiss, Eric S.; Scheel, Janet; Cameron, Duke E.; Vricella, Luca.

In: Journal of Heart and Lung Transplantation, Vol. 27, No. 10, 10.2008, p. 1085-1089.

Research output: Contribution to journalArticle

Patel, Nishant D. ; Weiss, Eric S. ; Scheel, Janet ; Cameron, Duke E. ; Vricella, Luca. / ABO-Incompatible Heart Transplantation in Infants : Analysis of the United Network for Organ Sharing Database. In: Journal of Heart and Lung Transplantation. 2008 ; Vol. 27, No. 10. pp. 1085-1089.
@article{116682c9f7e54b2c866594a7f1522f48,
title = "ABO-Incompatible Heart Transplantation in Infants: Analysis of the United Network for Organ Sharing Database",
abstract = "Introduction: ABO-incompatible heart transplantation, traditionally contraindicated because of the risk of hyperacute rejection, has been used selectively in recent years. Infants have limited production of isohemagglutinins, which may lower the risk of hyperacute rejection. A large national database was used to analyze the effect of ABO incompatibility on outcomes after heart transplantation in infants. Methods: Heart transplant recipients aged younger than 1 year reported to the United Network for Organ Sharing from 1999 to 2007 were divided according to donor-recipient ABO incompatibility or compatibility. Outcomes included Kaplan-Meier survival and hyperacute rejection. Propensity-adjusted Cox regression modeling was used to identify predictors of mortality. Results: Of 591 infants that underwent heart transplantation, 35 (6{\%}) received allografts from ABO-incompatible donors. ABO-incompatible recipients trended toward more congenital heart disease (71{\%} vs 66{\%}; p = 0.06) and were less likely to have dilated cardiomyopathy (11{\%} vs 29{\%}; p = 0.02). One ABO-incompatible infant had hyperacute rejection requiring retransplantation. No ABO-incompatible infant and 2 ABO-compatible infants died from hyperacute rejection. Survival was similar at 3 years. Propensity-adjusted Cox regression analysis demonstrated that ABO-incompatibility did not predict mortality (hazard ratio, 3.61; 95{\%} confidence interval, 0.26-49.0; p = 0.33). Conclusion: ABO-incompatible heart transplantation can be performed safely in infants without greater incidence of hyperacute rejection. ABO-incompatible heart transplantation should be strongly considered in infants to maximize donor organ utilization and reduce waiting-list mortality.",
author = "Patel, {Nishant D.} and Weiss, {Eric S.} and Janet Scheel and Cameron, {Duke E.} and Luca Vricella",
year = "2008",
month = "10",
doi = "10.1016/j.healun.2008.07.001",
language = "English (US)",
volume = "27",
pages = "1085--1089",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "10",

}

TY - JOUR

T1 - ABO-Incompatible Heart Transplantation in Infants

T2 - Analysis of the United Network for Organ Sharing Database

AU - Patel, Nishant D.

AU - Weiss, Eric S.

AU - Scheel, Janet

AU - Cameron, Duke E.

AU - Vricella, Luca

PY - 2008/10

Y1 - 2008/10

N2 - Introduction: ABO-incompatible heart transplantation, traditionally contraindicated because of the risk of hyperacute rejection, has been used selectively in recent years. Infants have limited production of isohemagglutinins, which may lower the risk of hyperacute rejection. A large national database was used to analyze the effect of ABO incompatibility on outcomes after heart transplantation in infants. Methods: Heart transplant recipients aged younger than 1 year reported to the United Network for Organ Sharing from 1999 to 2007 were divided according to donor-recipient ABO incompatibility or compatibility. Outcomes included Kaplan-Meier survival and hyperacute rejection. Propensity-adjusted Cox regression modeling was used to identify predictors of mortality. Results: Of 591 infants that underwent heart transplantation, 35 (6%) received allografts from ABO-incompatible donors. ABO-incompatible recipients trended toward more congenital heart disease (71% vs 66%; p = 0.06) and were less likely to have dilated cardiomyopathy (11% vs 29%; p = 0.02). One ABO-incompatible infant had hyperacute rejection requiring retransplantation. No ABO-incompatible infant and 2 ABO-compatible infants died from hyperacute rejection. Survival was similar at 3 years. Propensity-adjusted Cox regression analysis demonstrated that ABO-incompatibility did not predict mortality (hazard ratio, 3.61; 95% confidence interval, 0.26-49.0; p = 0.33). Conclusion: ABO-incompatible heart transplantation can be performed safely in infants without greater incidence of hyperacute rejection. ABO-incompatible heart transplantation should be strongly considered in infants to maximize donor organ utilization and reduce waiting-list mortality.

AB - Introduction: ABO-incompatible heart transplantation, traditionally contraindicated because of the risk of hyperacute rejection, has been used selectively in recent years. Infants have limited production of isohemagglutinins, which may lower the risk of hyperacute rejection. A large national database was used to analyze the effect of ABO incompatibility on outcomes after heart transplantation in infants. Methods: Heart transplant recipients aged younger than 1 year reported to the United Network for Organ Sharing from 1999 to 2007 were divided according to donor-recipient ABO incompatibility or compatibility. Outcomes included Kaplan-Meier survival and hyperacute rejection. Propensity-adjusted Cox regression modeling was used to identify predictors of mortality. Results: Of 591 infants that underwent heart transplantation, 35 (6%) received allografts from ABO-incompatible donors. ABO-incompatible recipients trended toward more congenital heart disease (71% vs 66%; p = 0.06) and were less likely to have dilated cardiomyopathy (11% vs 29%; p = 0.02). One ABO-incompatible infant had hyperacute rejection requiring retransplantation. No ABO-incompatible infant and 2 ABO-compatible infants died from hyperacute rejection. Survival was similar at 3 years. Propensity-adjusted Cox regression analysis demonstrated that ABO-incompatibility did not predict mortality (hazard ratio, 3.61; 95% confidence interval, 0.26-49.0; p = 0.33). Conclusion: ABO-incompatible heart transplantation can be performed safely in infants without greater incidence of hyperacute rejection. ABO-incompatible heart transplantation should be strongly considered in infants to maximize donor organ utilization and reduce waiting-list mortality.

UR - http://www.scopus.com/inward/record.url?scp=52949144860&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=52949144860&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2008.07.001

DO - 10.1016/j.healun.2008.07.001

M3 - Article

C2 - 18926398

AN - SCOPUS:52949144860

VL - 27

SP - 1085

EP - 1089

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 10

ER -