TY - JOUR
T1 - Association between recipient blood type and heart transplantation outcomes in the United States
AU - Ando, Masahiko
AU - Takeda, Koji
AU - Kurlansky, Paul A.
AU - Garan, Arthur R.
AU - Topkara, Veli K.
AU - Yuzefpolskaya, Melana
AU - Colombo, Paolo C.
AU - Farr, Maryjane
AU - Naka, Yoshifumi
AU - Takayama, Hiroo
N1 - Publisher Copyright:
© 2020 International Society for Heart and Lung Transplantation
PY - 2020/4
Y1 - 2020/4
N2 - BACKGROUND: In heart transplantation (HT), although blood type O organs can go to any blood type, non-O organs may not be allocated to adult O recipients. Therefore, O candidates wait longer than non-O candidates and frequently require bridging with left ventricular assist devices (LVADs). The effects of this discrepancy are rarely investigated in a large registry. The purpose of this study was to assess the association between candidates’ blood type and their outcomes after HT listing. METHODS: This is a retrospective cohort study using the United Network for Organ Sharing Registry, including 34,352 candidates listed for a single-organ, primary HT from January 2000 through December 2015. Main outcome measures were waitlist mortality and post-HT mortality, using blood type A as reference. We conducted inverse-probability weighting to adjust for baseline profiles. RESULTS: Among 34,352 candidates (median age 55, interquartile range 46–62; female 24.8%; blood type A: 13,258, AB: 1,572, B: 4,599, O:14,923), 22,714 candidates (A: 71.5%, AB: 82.1%, B: 73.0%, O: 57.5%; p < 0.001) underwent HT during the study period. Among recipients, bridging LVAD rate was highest in O recipients (A: 23.0%, AB: 15.3%, B: 23.4%, O: 32.1%; p < 0.001). After inverse-probability weighting, O patients demonstrated a significantly higher hazard of death after listing (adjusted hazard ratio 1.11, 95% confidence interval [CI] 1.07–1.16) and after HT (adjusted hazard ratio 1.07, 95% CI 1.01–1.13) as compared with A. CONCLUSIONS: There is a survival discrepancy among blood types. Our findings should facilitate more prospective studies to revisit current policies regarding equity in allocation, where possible.
AB - BACKGROUND: In heart transplantation (HT), although blood type O organs can go to any blood type, non-O organs may not be allocated to adult O recipients. Therefore, O candidates wait longer than non-O candidates and frequently require bridging with left ventricular assist devices (LVADs). The effects of this discrepancy are rarely investigated in a large registry. The purpose of this study was to assess the association between candidates’ blood type and their outcomes after HT listing. METHODS: This is a retrospective cohort study using the United Network for Organ Sharing Registry, including 34,352 candidates listed for a single-organ, primary HT from January 2000 through December 2015. Main outcome measures were waitlist mortality and post-HT mortality, using blood type A as reference. We conducted inverse-probability weighting to adjust for baseline profiles. RESULTS: Among 34,352 candidates (median age 55, interquartile range 46–62; female 24.8%; blood type A: 13,258, AB: 1,572, B: 4,599, O:14,923), 22,714 candidates (A: 71.5%, AB: 82.1%, B: 73.0%, O: 57.5%; p < 0.001) underwent HT during the study period. Among recipients, bridging LVAD rate was highest in O recipients (A: 23.0%, AB: 15.3%, B: 23.4%, O: 32.1%; p < 0.001). After inverse-probability weighting, O patients demonstrated a significantly higher hazard of death after listing (adjusted hazard ratio 1.11, 95% confidence interval [CI] 1.07–1.16) and after HT (adjusted hazard ratio 1.07, 95% CI 1.01–1.13) as compared with A. CONCLUSIONS: There is a survival discrepancy among blood types. Our findings should facilitate more prospective studies to revisit current policies regarding equity in allocation, where possible.
KW - blood type
KW - heart transplantation
KW - organ allocation
KW - outcome
KW - survival
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U2 - 10.1016/j.healun.2019.12.006
DO - 10.1016/j.healun.2019.12.006
M3 - Article
C2 - 32014332
AN - SCOPUS:85078751564
SN - 1053-2498
VL - 39
SP - 363
EP - 370
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 4
ER -