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. 2022 Sep;164(3):981-993.e8.
doi: 10.1016/j.jtcvs.2020.12.123. Epub 2021 Jan 12.

Impact of donor blood type on outcomes after prolonged allograft ischemic times

Paul C Tang  1 , Jonathan W Haft  2 , Ienglam Lei  2 , Zhong Wang  2 , Y Eugene Chen  3 , Ashraf Abou El Ela  2 , Xiaoting Wu  2 , Bertram Pitt  4 , Keith D Aaronson  4 , Francis D Pagani  2
Affiliations

Impact of donor blood type on outcomes after prolonged allograft ischemic times

Paul C Tang et al. J Thorac Cardiovasc Surg. 2022 Sep.

Abstract

Objective: The study objective was to determine the influence of allograft ischemic time on heart transplant outcomes among ABO donor organ types given limited prior reports of its survival impact.

Methods: We identified 32,454 heart transplants (2000-2016) from the United Network for Organ Sharing database. Continuous and categoric variables were analyzed by parametric and nonparametric testing. Survival was determined using log-rank or Cox regression tests. Propensity matching adjusted for preoperative variables.

Results: By comparing allograft ischemic time less than 4 hours (n = 6579) with 4 hours or more (n = 25,875), the hazard ratios for death at 15 years after prolonged ischemic time (≥4 hours) for blood types O, A, B, and AB were 1.106 (P < .001), 1.062 (P < .001), 1.059 (P = .062), and 1.114 (P = .221), respectively. Unadjusted data demonstrated higher mortality for transplantation of O versus non-O donor hearts for ischemic time 4 hours or more (hazard ratio, 1.164; P < .001). After propensity matching, O donor hearts continued to have worse survival if preserved for 4 hours or more (hazard ratio, 1.137, P = .008), but not if ischemic time was less than 4 hours (hazard ratio, 1.042, P = .113). In a matched group with 4 hours or more of ischemic time, patients receiving O donor organs were more likely to experience death from primary graft dysfunction (2.5% vs 1.7%, P = .052) and chronic allograft rejection (1.9% vs 1.1%, P = .021). No difference in death from primary graft dysfunction or chronic allograft rejection was seen with less than 4 hours of ischemic time (P > .150).

Conclusions: Compared with non-O donor hearts, transplantation with O donor hearts with ischemic time 4 hours or more leads to worse survival, with higher rates of primary graft dysfunction and chronic rejection. Caution should be practiced when considering donor hearts with the O blood type when anticipating extended cold ischemic times.

Keywords: myocardial protection; reperfusion; transplantation-heart.

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Figures

FIGURE 1.
FIGURE 1.
O donor hearts subjected to prolonged ischemic times of 4 hours and beyond experience poorer outcomes. HR, Hazard ratio.
FIGURE 2.
FIGURE 2.
Comparison of survival between (A) ABO blood groups with allograft ischemic time of 4 hours or more. The 95% confidence intervals for survival are represented in shaded areas. O blood group donor hearts show poorer likelihood of survival at 5, 10, and 15 years in (B) unadjusted and (C) propensity-matched populations. HR, Hazard ratio.
FIGURE 3.
FIGURE 3.
Comparison of survival between (A) ABO blood groups with allograft ischemic time less than 4 hours. The 95% confidence intervals for survival are represented in shaded areas. O and non-O blood group donor hearts show similar survival at 5, 10, and 15 years in (B) unadjusted and (C) propensity-matched populations. HR, Hazard ratio.
FIGURE 4.
FIGURE 4.
Differences in survival for donor hearts with allograft ischemic time less than 4 hours or 4 hours or more according to ABO blood group. The 95% confidence intervals for survival are represented in shaded areas. A, O donor hearts have the greatest detriment in survival when ischemic times extend to 4 hours and more compared with blood groups (B) A, (C) B, and (D) AB. HR, Hazard ratio.
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