BACKGROUND

Heart transplantation from ABO incompatible (ABOi) donors has evolved into a progressively accepted therapy in young children. We assessed the recent practice of ABOi listing impact on waitlist and post-transplant outcomes.

METHODS

Using the Pediatric Heart Transplant Society registry, we compared clinical presentation, waitlist parameters, and post-transplant survival of children < 2 years of age listed for ABOi vs ABO compatible (ABOc) heart transplant between January 2010 and June 2018 with sub-analysis of blood group O recipients.

RESULTS

Among 2,039 patients, ABOi listing increased significantly with time from 49% (2010) to 72% (2017). ABOi-listed patients had lower age and body surface area, and higher proportion of congenital heart disease, mechanical ventilation, and high urgency status (all p < 0.01). Use of mechanical circulatory support was similar between groups. Of 1,288 patients reaching transplant, 239 (18.6%) received an ABOi organ (15%–40%/year). Death while waiting, removal from the waitlist, and waitlist survival were similar between groups. Time to transplant was significantly shorter for ABOi listing in blood group O patients (p < 0.02), approaching significance (p = 0.057) for all blood groups. Post-transplant survival was similar except for lower survival of patients listed ABOc but transplanted ABOi. These patients showed increasing need for mechanical circulatory support and high urgency listing while waiting.

CONCLUSIONS

In the current era, primary listing for ABOi heart transplant has become routine for the majority of children < 2 years old, resulting in shorter waitlist time, especially in blood group O. Post-transplant survival is similar despite ABOi-listed children still showing a higher risk profile.

中文翻译：

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当前时代的ABO不兼容列表操作及其对需要心脏移植的幼儿的结局影响的分析。

背景

来自ABO不相容（ABOi）供体的心脏移植已演变成一种逐渐被幼儿接受的疗法。我们评估了ABOi上市对轮候名单和移植后结果影响的最新实践。

方法

我们使用儿科心脏移植协会注册表对2010年1月至2018年6月间ABOi与ABOc兼容（ABOc）心脏移植所列2岁以下儿童的临床表现，候诊参数和移植后存活率进行了亚组分析。血型O受者。

结果

在2,039名患者中，ABOi列表随时间显着增加，从49％（2010）增至72％（2017）。被ABOi列入名单的患者年龄和体表面积较低，先天性心脏病，机械通气和紧急状态的比例更高（所有p <0.01）。两组之间使用机械循环支持的情况相似。在接受移植的1,288名患者中，有239名（18.6％）接受了ABOi器官（15％–40％/年）。两组之间等待时死亡，从等待列表中删除和等待列表生存率相似。O型血患者ABOi上市的时间显着缩短（p <0.02），接近显着性（p = 0.057）。移植后的存活率相似，除了列出ABOc但移植了ABOi的患者存活率较低。这些患者在等待时显示出对机械循环支持的需求不断增加，并且急诊清单也越来越高。

结论

在当前时代，ABOi心脏移植的主要清单已成为大多数2岁以下儿童的常规做法，从而缩短了等待名单的时间，特别是在血型O人群中。尽管ABOi清单所列的儿童仍显示出ABOi心脏移植的存活期相似较高的风险状况。