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Recipient and Donor Characteristics - Impact on Outcome after Heart Transplantation

Bergenfeldt, Henrik LU (2016)
Abstract
Heart transplantation (HTx) is severely limited by a shortage of donors. This thesis aimed to investigate the effectof variables used to match donors to recipients in HTx.Methods: Data from the ISHLT registry was used to study: I: Identical versus compatible non-identical ABOmatchingin 3,589 AB HTx recipients. II: Outcomes of 94 ABO-incompatible transplants were compared to anABO-compatible group. III: Evaluation of the effect of sex and body size-matching with special reference to obeserecipients. IV: Investigation of the association between donor and recipient age on early and late post-transplantmortality.Results: Study I: There was no difference in survival between identically and non-identically ABO matchedtransplants. Study II: The... (More)
Heart transplantation (HTx) is severely limited by a shortage of donors. This thesis aimed to investigate the effectof variables used to match donors to recipients in HTx.Methods: Data from the ISHLT registry was used to study: I: Identical versus compatible non-identical ABOmatchingin 3,589 AB HTx recipients. II: Outcomes of 94 ABO-incompatible transplants were compared to anABO-compatible group. III: Evaluation of the effect of sex and body size-matching with special reference to obeserecipients. IV: Investigation of the association between donor and recipient age on early and late post-transplantmortality.Results: Study I: There was no difference in survival between identically and non-identically ABO matchedtransplants. Study II: The incidence of death or retransplantation was higher for ABO-incompatible recipients. After2005, the rate ABO-incompatible HTx in adults increased, likely due to planned ABO-incompatibility. For theserecipients, outcomes were similar to ABO-compatible recipients. Study III: Recipient-donor weight difference >30%predicted mortality in non-obese but not obese recipients. Sex mismatched transplants had impaired survival.There was no modification of the association between size matching and mortality risk by sex matching. Study IV:Recipient and donor age was associated with both early and late mortality. However, donor age influencedpredominantly early mortality, while recipient age influenced predominantly long-term mortality.ABO-identical blood group matching has no survival benefit for AB recipients. ABO-incompatible hearttranplantation may be feasible in carefully selected adult patients. Current weight matching guidelines can likely beexpanded for obese heart transplant recipients. Sex mismatch is a disadvantageous factor in hearttransplantation, not only in the context of size mismatch. Donor age appears to have a larger impact on earlymortality, likely due to a higher incidence of primary graft dysfunction. Recipient age appears to have a largerimpact on late mortality likely due to effects of immunosenescence. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Ahn, Henrik, Linköping University
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Heart Transplantation
pages
92 pages
publisher
Lund University: Faculty of Medicine
defense location
Segerfalksalen, Wallenberg Neurocentrum, Sölvegatan 17, Lund
defense date
2016-09-02 13:00:00
ISBN
978-91-7619-308-2
language
English
LU publication?
yes
additional info
ISSN: 1652-8220 Lund University, Faculty of Medicine Doctoral Dissertation Series 2016:82
id
0b6bd150-6e2f-49c7-b122-c79c76f7f13d
date added to LUP
2016-08-11 13:53:59
date last changed
2021-03-22 16:55:28
@phdthesis{0b6bd150-6e2f-49c7-b122-c79c76f7f13d,
  abstract     = {{Heart transplantation (HTx) is severely limited by a shortage of donors. This thesis aimed to investigate the effectof variables used to match donors to recipients in HTx.Methods: Data from the ISHLT registry was used to study: I: Identical versus compatible non-identical ABOmatchingin 3,589 AB HTx recipients. II: Outcomes of 94 ABO-incompatible transplants were compared to anABO-compatible group. III: Evaluation of the effect of sex and body size-matching with special reference to obeserecipients. IV: Investigation of the association between donor and recipient age on early and late post-transplantmortality.Results: Study I: There was no difference in survival between identically and non-identically ABO matchedtransplants. Study II: The incidence of death or retransplantation was higher for ABO-incompatible recipients. After2005, the rate ABO-incompatible HTx in adults increased, likely due to planned ABO-incompatibility. For theserecipients, outcomes were similar to ABO-compatible recipients. Study III: Recipient-donor weight difference >30%predicted mortality in non-obese but not obese recipients. Sex mismatched transplants had impaired survival.There was no modification of the association between size matching and mortality risk by sex matching. Study IV:Recipient and donor age was associated with both early and late mortality. However, donor age influencedpredominantly early mortality, while recipient age influenced predominantly long-term mortality.ABO-identical blood group matching has no survival benefit for AB recipients. ABO-incompatible hearttranplantation may be feasible in carefully selected adult patients. Current weight matching guidelines can likely beexpanded for obese heart transplant recipients. Sex mismatch is a disadvantageous factor in hearttransplantation, not only in the context of size mismatch. Donor age appears to have a larger impact on earlymortality, likely due to a higher incidence of primary graft dysfunction. Recipient age appears to have a largerimpact on late mortality likely due to effects of immunosenescence.}},
  author       = {{Bergenfeldt, Henrik}},
  isbn         = {{978-91-7619-308-2}},
  keywords     = {{Heart Transplantation}},
  language     = {{eng}},
  publisher    = {{Lund University: Faculty of Medicine}},
  school       = {{Lund University}},
  title        = {{Recipient and Donor Characteristics - Impact on Outcome after Heart Transplantation}},
  url          = {{https://lup.lub.lu.se/search/files/10790754/E_spik_Henrik_kappa.pdf}},
  year         = {{2016}},
}