Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
J Heart Lung Transplant. 2020 Jul;39(7):627-635. doi: 10.1016/j.healun.2020.02.008. Epub 2020 Mar 20.
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.
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.
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.
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.
ABO 血型不相容（ABOi）供体的心脏移植已逐渐成为小儿患者可接受的治疗方法。我们评估了 ABOi 列入名单对候补名单和移植后结果的近期影响。
使用小儿心脏移植协会的登记处，我们比较了 2010 年 1 月至 2018 年 6 月期间，年龄小于 2 岁的 ABOi 与 ABO 相容（ABOc）心脏移植患者的临床特征、候补名单参数和移植后生存率，对 O 型血受者进行了亚分析。
在 2039 例患者中，ABOi 列入名单的比例随着时间的推移显著增加，从 2010 年的 49%增加到 2017 年的 72%。ABOi 列入名单的患者年龄和体表面积较小，先天性心脏病、机械通气和高紧急状态的比例较高（均 p<0.01）。两组之间使用机械循环支持的情况相似。在 1288 例达到移植的患者中，239 例（18.6%）接受了 ABOi 器官（15%-40%/年）。两组患者等待期间死亡、从候补名单中删除和候补名单生存率相似。对于 O 型血患者，ABOi 列入名单的移植时间明显缩短（p<0.02），对于所有血型均接近显著（p=0.057）。除了 ABOc 列入名单但 ABOi 移植的患者存活率较低外，移植后的生存率相似。这些患者在等待期间机械循环支持和高紧急状态的需求增加。
在当前时代，ABOi 心脏移植的初次列入名单已成为大多数<2 岁儿童的常规治疗方法，导致候补名单时间缩短，尤其是在 O 型血患者中。尽管 ABOi 列入名单的儿童仍存在较高的风险特征，但移植后的生存率相似。
