Divisions of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York.
Divisions of Cardiac Surgery, Columbia University Irving Medical Center, New York, New York.
J Heart Lung Transplant. 2020 Apr;39(4):363-370. doi: 10.1016/j.healun.2019.12.006. Epub 2020 Jan 21.
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.
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.
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.
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.
在心脏移植（HT）中，尽管血型 O 的器官可以分配给任何血型，但非 O 型器官可能不会分配给成人 O 型受者。因此，O 型候选者等待的时间比非 O 型候选者长，并且经常需要使用左心室辅助装置（LVAD）进行桥接。这种差异的影响在大型登记处很少被调查。本研究的目的是评估候选者的血型与其 HT 列表后的结果之间的关联。
这是一项使用美国器官共享网络登记处的回顾性队列研究，包括 2000 年 1 月至 2015 年 12 月期间接受单一器官、原发性 HT 的 34352 名候选者。主要观察指标是等待名单死亡率和 HT 后死亡率，以血型 A 为参照。我们进行了逆概率加权以调整基线特征。
在 34352 名候选者中（中位年龄 55 岁，四分位距 46-62；女性 24.8%；血型 A：13258，AB：1572，B：4599，O：14923），22714 名候选者（A：71.5%，AB：82.1%，B：73.0%，O：57.5%；p < 0.001）在研究期间接受了 HT。在受者中，O 型受者的 LVAD 桥接率最高（A：23.0%，AB：15.3%，B：23.4%，O：32.1%；p < 0.001）。在逆概率加权后，O 型患者在列表后（调整后的危险比 1.11，95%置信区间[CI] 1.07-1.16）和 HT 后（调整后的危险比 1.07，95% CI 1.01-1.13）的死亡风险显著更高。
血型之间存在生存差异。我们的发现应该有助于更多的前瞻性研究来重新审视当前关于分配公平性的政策，在可能的情况下。
