Blood type O heart transplant candidates have longer waitlist time and higher delisting under the new allocation system

Prior studies have examined the effect of blood type on heart transplantation (HTx) waitlist outcomes in cohorts through 2015. We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus. Adults listed for HTx between April 2015 and December 2020 w...

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Veröffentlicht in:	The Journal of thoracic and cardiovascular surgery 2024-01, Vol.167 (1), p.231-240.e7
Hauptverfasser:	Eapen, Sarah, Nordan, Taylor, Critsinelis, Andre C, Li, Borui, Chen, Frederick Y, Couper, Gregory S, Kawabori, Masashi
Format:	Artikel
Sprache:	eng
Schlagworte:	Adult Heart Failure - surgery Heart Transplantation - adverse effects Heart-Assist Devices Humans Retrospective Studies Tissue Donors Waiting Lists
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creator	Eapen, Sarah Nordan, Taylor Critsinelis, Andre C Li, Borui Chen, Frederick Y Couper, Gregory S Kawabori, Masashi
description	Prior studies have examined the effect of blood type on heart transplantation (HTx) waitlist outcomes in cohorts through 2015. We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus. Adults listed for HTx between April 2015 and December 2020 were included. Survival to HTx and waitlist death/deterioration was compared between type O and non-type O candidates using competing risks regression. Donor/recipient ABO compatibility trends were further investigated. Candidates with blood type O (n = 7509) underwent HTx less frequently than candidates with blood type other than type O (n = 9699) (subhazard ratio [sHR], 0.56; 95% CI, 0.53-0.58) with higher rates of waitlist death/deterioration (sHR, 1.18; 95% CI, 1.04-1.34). Subgroup analyses demonstrated persistence of this trend under the new donor heart allocation system (HTx: sHR, 0.58; 95% CI, 0.54-0.62; death/clinical deterioration: sHR, 1.27; 95% CI, 1.02-1.60), especially among those listed at high status (1, 2, or 3) (HTx: sHR, 0.69; 95% CI, 0.63-0.75; death/deterioration: sHR, 1.61; 95% CI, 1.16-2.22). Among those listed at status 3, waitlist death/deterioration was modified by presence of a durable left ventricular assist device (left ventricular assist device: sHR, 1.57; 95% CI, 0.58-4.29; no left ventricular assist device: sHR, 3.79; 95% CI, 1.28-11.2). Type O donor heart allocation to secondary ABO candidates increased in the new system (14.5% vs 12.0%; P
doi_str_mv	10.1016/j.jtcvs.2022.07.029
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We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus. Adults listed for HTx between April 2015 and December 2020 were included. Survival to HTx and waitlist death/deterioration was compared between type O and non-type O candidates using competing risks regression. Donor/recipient ABO compatibility trends were further investigated. Candidates with blood type O (n = 7509) underwent HTx less frequently than candidates with blood type other than type O (n = 9699) (subhazard ratio [sHR], 0.56; 95% CI, 0.53-0.58) with higher rates of waitlist death/deterioration (sHR, 1.18; 95% CI, 1.04-1.34). Subgroup analyses demonstrated persistence of this trend under the new donor heart allocation system (HTx: sHR, 0.58; 95% CI, 0.54-0.62; death/clinical deterioration: sHR, 1.27; 95% CI, 1.02-1.60), especially among those listed at high status (1, 2, or 3) (HTx: sHR, 0.69; 95% CI, 0.63-0.75; death/deterioration: sHR, 1.61; 95% CI, 1.16-2.22). Among those listed at status 3, waitlist death/deterioration was modified by presence of a durable left ventricular assist device (left ventricular assist device: sHR, 1.57; 95% CI, 0.58-4.29; no left ventricular assist device: sHR, 3.79; 95% CI, 1.28-11.2). Type O donor heart allocation to secondary ABO candidates increased in the new system (14.5% vs 12.0%; P < .01); post-HTx survival remained comparable between recipients with blood type O and non-type O (log-rank P = .07). Further logistical considerations are warranted to minimize allocation inequity regarding blood type under the new allocation system.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2022.07.029</identifier><identifier>PMID: 36100474</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Heart Failure - surgery ; Heart Transplantation - adverse effects ; Heart-Assist Devices ; Humans ; Retrospective Studies ; Tissue Donors ; Waiting Lists</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2024-01, Vol.167 (1), p.231-240.e7</ispartof><rights>Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. 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We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus. Adults listed for HTx between April 2015 and December 2020 were included. Survival to HTx and waitlist death/deterioration was compared between type O and non-type O candidates using competing risks regression. Donor/recipient ABO compatibility trends were further investigated. Candidates with blood type O (n = 7509) underwent HTx less frequently than candidates with blood type other than type O (n = 9699) (subhazard ratio [sHR], 0.56; 95% CI, 0.53-0.58) with higher rates of waitlist death/deterioration (sHR, 1.18; 95% CI, 1.04-1.34). Subgroup analyses demonstrated persistence of this trend under the new donor heart allocation system (HTx: sHR, 0.58; 95% CI, 0.54-0.62; death/clinical deterioration: sHR, 1.27; 95% CI, 1.02-1.60), especially among those listed at high status (1, 2, or 3) (HTx: sHR, 0.69; 95% CI, 0.63-0.75; death/deterioration: sHR, 1.61; 95% CI, 1.16-2.22). Among those listed at status 3, waitlist death/deterioration was modified by presence of a durable left ventricular assist device (left ventricular assist device: sHR, 1.57; 95% CI, 0.58-4.29; no left ventricular assist device: sHR, 3.79; 95% CI, 1.28-11.2). Type O donor heart allocation to secondary ABO candidates increased in the new system (14.5% vs 12.0%; P < .01); post-HTx survival remained comparable between recipients with blood type O and non-type O (log-rank P = .07). Further logistical considerations are warranted to minimize allocation inequity regarding blood type under the new allocation system.</description><subject>Adult</subject><subject>Heart Failure - surgery</subject><subject>Heart Transplantation - adverse effects</subject><subject>Heart-Assist Devices</subject><subject>Humans</subject><subject>Retrospective Studies</subject><subject>Tissue Donors</subject><subject>Waiting Lists</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kMtu2zAQRYkgRe2k_YIABZfZSB2SkkgtWyOPAgG88aI7giJHFg09XJG24b8vXSddzePemcEcQh4Y5AxY9X2X76I9hpwD5znIHHh9Q5YMaplVqvx9S5aQlKzkXCzIXQg7AJDA6s9kISoGUMhiSU4_-2lyNJ73SNe0QzNHGmczhn1vxkitGZ13JmKgnTki7adxizM9GR97H5LVD0iTh3Z-2yXB4aXtxy09jC7VsUM64omavp-siX4aaTiHiMMX8qk1fcCv7_GebJ6fNqvX7G398mv14y2zAsqYiVaiQsOYFdYp29SqLphqLViLvE2Jrco2xZZXTcMbVZSytQ1XzimHRoh78nhdu5-nPwcMUQ8-WOzTczgdguaSFaIGBTJZxdVq5ymEGVu9n_1g5rNmoC_A9U7_A64vwDVInYCnqW_vBw7NgO7_zAdh8RfzzoHe</recordid><startdate>202401</startdate><enddate>202401</enddate><creator>Eapen, Sarah</creator><creator>Nordan, Taylor</creator><creator>Critsinelis, Andre C</creator><creator>Li, Borui</creator><creator>Chen, Frederick Y</creator><creator>Couper, Gregory S</creator><creator>Kawabori, Masashi</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202401</creationdate><title>Blood type O heart transplant candidates have longer waitlist time and higher delisting under the new allocation system</title><author>Eapen, Sarah ; Nordan, Taylor ; Critsinelis, Andre C ; Li, Borui ; Chen, Frederick Y ; Couper, Gregory S ; Kawabori, Masashi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-3f7e8ea11c3cd8cb989418fc0cce2f8fcc65ff8ff26bb2b8457fcb28dd8dea33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Heart Failure - surgery</topic><topic>Heart Transplantation - adverse effects</topic><topic>Heart-Assist Devices</topic><topic>Humans</topic><topic>Retrospective Studies</topic><topic>Tissue Donors</topic><topic>Waiting Lists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eapen, Sarah</creatorcontrib><creatorcontrib>Nordan, Taylor</creatorcontrib><creatorcontrib>Critsinelis, Andre C</creatorcontrib><creatorcontrib>Li, Borui</creatorcontrib><creatorcontrib>Chen, Frederick Y</creatorcontrib><creatorcontrib>Couper, Gregory S</creatorcontrib><creatorcontrib>Kawabori, Masashi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eapen, Sarah</au><au>Nordan, Taylor</au><au>Critsinelis, Andre C</au><au>Li, Borui</au><au>Chen, Frederick Y</au><au>Couper, Gregory S</au><au>Kawabori, Masashi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood type O heart transplant candidates have longer waitlist time and higher delisting under the new allocation system</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2024-01</date><risdate>2024</risdate><volume>167</volume><issue>1</issue><spage>231</spage><epage>240.e7</epage><pages>231-240.e7</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Prior studies have examined the effect of blood type on heart transplantation (HTx) waitlist outcomes in cohorts through 2015. We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus. Adults listed for HTx between April 2015 and December 2020 were included. Survival to HTx and waitlist death/deterioration was compared between type O and non-type O candidates using competing risks regression. Donor/recipient ABO compatibility trends were further investigated. Candidates with blood type O (n = 7509) underwent HTx less frequently than candidates with blood type other than type O (n = 9699) (subhazard ratio [sHR], 0.56; 95% CI, 0.53-0.58) with higher rates of waitlist death/deterioration (sHR, 1.18; 95% CI, 1.04-1.34). Subgroup analyses demonstrated persistence of this trend under the new donor heart allocation system (HTx: sHR, 0.58; 95% CI, 0.54-0.62; death/clinical deterioration: sHR, 1.27; 95% CI, 1.02-1.60), especially among those listed at high status (1, 2, or 3) (HTx: sHR, 0.69; 95% CI, 0.63-0.75; death/deterioration: sHR, 1.61; 95% CI, 1.16-2.22). 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subjects	Adult Heart Failure - surgery Heart Transplantation - adverse effects Heart-Assist Devices Humans Retrospective Studies Tissue Donors Waiting Lists
title	Blood type O heart transplant candidates have longer waitlist time and higher delisting under the new allocation system
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