Heart transplantation from donors of different ABO blood type

ABO blood group compatibility between donors and recipients of heart transplants is required to reduce the risk of hyperacute rejection. Ideally, ABO-identical cardiac grafts should be used but transplantating using ABO compatible types allows reduced waiting times among recipients with rarer types without a significant increase in hyperacute rejection. However, previous reports have indicated that use of donors with minor ABO mismatches may adversely influence late outcomes, although more recent studies do not confirm this suggestion. Our purpose was to analyze this practice in our center.

We analyzed 121 patients who underwent heart transplantation between November 2003 and May 2008. One hundred nine patients (90.0%) received ABO-matched grafts (population 1 [P1]) and 12 (9.9%) received ABO-compatible grafts (population 2 [P2]). P1 included 60 group A, 44 group 0, and 5 group B patients; P2 included 5 group A, 5 group B, and 2 group AB patients. The populations did not differ statistically in age, gender, urgency status, surgical technique, ischemic time, donor features, or immunosuppression. They were assessed for left ventricle ejection fraction (LVEF), rejection, and mortality.

There were no significant differences in total mortality (P1, 13.7%; P2, 8.3%), rejection grade > or =2R (P1, 21.1%; P2, 33.3%), or LVEF (6 months: P1, 65%; P2, 71%; 1 year: P1, 68%; P2, 69%).

Minor ABO mismatches did not adversely affect 1-year outcomes of heart transplantation. This practice may facilitate organ allocation for end-stage heart failure patients, thereby reducing waiting time for heart transplantation.