A current era analysis of ABO incompatible listing practice and impact on outcomes in young children requiring heart transplantation

Simon Urschel, Marie McCoy, Ryan S. Cantor, Devin A. Koehl, Warren A. Zuckerman, Anne I. Dipchand, Zdenka Reinhardt, Kirk R. Kanter, Jean A. Ballweg, Joshua Sparks, James K. Kirklin, Waldemar F. Carlo

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


BACKGROUND: Heart transplantation from ABO incompatible (ABOi) donors has evolved into a progressively accepted therapy in young children. We assessed the recent practice of ABOi listing impact on waitlist and post-transplant outcomes. METHODS: Using the Pediatric Heart Transplant Society registry, we compared clinical presentation, waitlist parameters, and post-transplant survival of children < 2 years of age listed for ABOi vs ABO compatible (ABOc) heart transplant between January 2010 and June 2018 with sub-analysis of blood group O recipients. RESULTS: Among 2,039 patients, ABOi listing increased significantly with time from 49% (2010) to 72% (2017). ABOi-listed patients had lower age and body surface area, and higher proportion of congenital heart disease, mechanical ventilation, and high urgency status (all p < 0.01). Use of mechanical circulatory support was similar between groups. Of 1,288 patients reaching transplant, 239 (18.6%) received an ABOi organ (15%–40%/year). Death while waiting, removal from the waitlist, and waitlist survival were similar between groups. Time to transplant was significantly shorter for ABOi listing in blood group O patients (p < 0.02), approaching significance (p = 0.057) for all blood groups. Post-transplant survival was similar except for lower survival of patients listed ABOc but transplanted ABOi. These patients showed increasing need for mechanical circulatory support and high urgency listing while waiting. CONCLUSIONS: In the current era, primary listing for ABOi heart transplant has become routine for the majority of children < 2 years old, resulting in shorter waitlist time, especially in blood group O. Post-transplant survival is similar despite ABOi-listed children still showing a higher risk profile.

Original languageEnglish (US)
Pages (from-to)627-635
Number of pages9
JournalJournal of Heart and Lung Transplantation
Issue number7
StatePublished - Jul 2020
Externally publishedYes


  • BO incompatible heart transplantation
  • donor organ allocation
  • immature immune system
  • pediatric heart transplantation
  • waitlist survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation


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