Broadening ABO Incompatibility Pediatric Heart Transplantation, Even in Children 2 Years and Older

Abstract

Purpose Blood type ABO incompatibility (ABOi) is becoming increasingly utilized in heart transplantation. We sought to identify whether this increase was mostly in infants or older children as well. Methods Pediatric patients ( Results From 2000-2017, there were 415 ABOi transplants completed in children up to 13 years of age. ABOi transplantation volume over time is shown in Figure 1. Of ABOi transplants, 70% (n=291) were done in North America (NA) and 28% (n=115) in Europe. The proportion of ABOi transplants was 4.6% in NA and 4.5% in Europe (p=0.87). When examined by era, this proportion has increased from 3.5% (2000-2008) to 5.3% (2009-2017), p Conclusion Willingness to accept ABOi allografts has continued to increase in the recent era, especially among pediatric candidates >2 years old. The trends in ABOi transplants are similar between NA and Europe. In the U.S., 1/5th of the recipients listed as ABOi transplant acceptable ultimately received ABOi transplant. Survival among the expanding group of ABOi pediatric heart transplant recipients compares favorably to ABO compatible transplants. These outcomes should encourage centers to use ABOi donors, particularly in select older children.