Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. Export

@article{citeulike:757035, abstract = {BACKGROUND: Recent data suggest that ABO blood group-incompatible donor hearts are immunologically well tolerated in infants undergoing transplantation. METHODS: Competing-risks methodology was used to assess outcomes after listing and the impact of a strategy to accept heart grafts from any blood group donor for infants less than 18 months of age. RESULTS: From 1992 to 2002, there were 91 listing episodes in 84 patients (including 20 fetuses; 50\% were male and 63\% had congenital heart disease). Beginning in 1995, a strategy to accept ABO-incompatible organs was adopted. Competing-risks analysis showed that after 20 months 60\% underwent transplantation, 18\% died, and less than 1\% were still listed; the remaining 21\% were de-listed because of a change of surgical strategy (9\%), improved clinical condition (8\%), and deterioration to ineligibility (4\%). Risk factors for transplantation included only a strategy to accept ABO-incompatible organs (P <.001). Risk factors for death included failure to accept ABO-incompatible organs (P =.002) and Canadian listing status 3 (P =.085) or 4 (P <.001). Multivariable parametric models were used to create competing risk predictions for outcomes specific to status and ABO-incompatible strategy. Higher status resulted in greater mortality regardless of strategy, although for any status, more patients underwent transplantation and fewer died using a strategy to accept ABO-incompatible organs. Parametric modeling of time-related freedom from death or retransplantation demonstrated no significant difference at 4 years posttransplantation (P =.78) for ABO-incompatible (74\%) versus ABO-compatible transplants (72\%). CONCLUSIONS: A strategy to accept ABO-incompatible donor hearts for infant transplantation significantly improves the likelihood of transplantation and reduces waiting list mortality while not adversely altering outcomes after transplantation.}, address = {Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.}, author = {West, L. J. and Karamlou, T. and Dipchand, A. I. and Pollock-BarZiv, S. M. and Coles, J. G. and McCrindle, B. W.}, citeulike-article-id = {757035}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.jtcvs.2005.09.048}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16434278}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16434278}, doi = {10.1016/j.jtcvs.2005.09.048}, issn = {1097-685X}, journal = {J Thorac Cardiovasc Surg}, keywords = {donor, heart, incompatible}, month = {February}, number = {2}, pages = {455--461}, posted-at = {2006-07-13 13:13:44}, priority = {2}, title = {Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants.}, url = {http://dx.doi.org/10.1016/j.jtcvs.2005.09.048}, volume = {131}, year = {2006} }

TY - JOUR ID - citeulike:757035 L3 - citeulike-article-id:757035 N2 - BACKGROUND: Recent data suggest that ABO blood group-incompatible donor hearts are immunologically well tolerated in infants undergoing transplantation. METHODS: Competing-risks methodology was used to assess outcomes after listing and the impact of a strategy to accept heart grafts from any blood group donor for infants less than 18 months of age. RESULTS: From 1992 to 2002, there were 91 listing episodes in 84 patients (including 20 fetuses; 50% were male and 63% had congenital heart disease). Beginning in 1995, a strategy to accept ABO-incompatible organs was adopted. Competing-risks analysis showed that after 20 months 60% underwent transplantation, 18% died, and less than 1% were still listed; the remaining 21% were de-listed because of a change of surgical strategy (9%), improved clinical condition (8%), and deterioration to ineligibility (4%). Risk factors for transplantation included only a strategy to accept ABO-incompatible organs (P <.001). Risk factors for death included failure to accept ABO-incompatible organs (P =.002) and Canadian listing status 3 (P =.085) or 4 (P <.001). Multivariable parametric models were used to create competing risk predictions for outcomes specific to status and ABO-incompatible strategy. Higher status resulted in greater mortality regardless of strategy, although for any status, more patients underwent transplantation and fewer died using a strategy to accept ABO-incompatible organs. Parametric modeling of time-related freedom from death or retransplantation demonstrated no significant difference at 4 years posttransplantation (P =.78) for ABO-incompatible (74%) versus ABO-compatible transplants (72%). CONCLUSIONS: A strategy to accept ABO-incompatible donor hearts for infant transplantation significantly improves the likelihood of transplantation and reduces waiting list mortality while not adversely altering outcomes after transplantation. IS - 2 JF - J Thorac Cardiovasc Surg SN - 1097-685X AD - Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. EP - 461 TI - Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. VL - 131 SP - 455 KW - donor KW - heart KW - incompatible AU - West, LJ AU - Karamlou, T AU - Dipchand, AI AU - Pollock-BarZiv, SM AU - Coles, JG AU - McCrindle, BW PY - 2006/02// UR - http://dx.doi.org/10.1016/j.jtcvs.2005.09.048 ER -