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Recipient and Donor Characteristics - Impact on Outcome after Heart Transplantation

Bergenfeldt, Henrik LU (2016)
Abstract (Swedish)
Heart transplantation (HTx) is severely limited by a shortage of donors. This thesis aimed to investigate the effect
of 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 ABOmatching
in 3,589 AB HTx recipients. II: Outcomes of 94 ABO-incompatible transplants were compared to an
ABO-compatible group. III: Evaluation of the effect of sex and body size-matching with special reference to obese
recipients. IV: Investigation of the association between donor and recipient age on early and late post-transplant
mortality.
Results: Study I: There was no difference in survival between identically and non-identically ABO... (More)
Heart transplantation (HTx) is severely limited by a shortage of donors. This thesis aimed to investigate the effect
of 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 ABOmatching
in 3,589 AB HTx recipients. II: Outcomes of 94 ABO-incompatible transplants were compared to an
ABO-compatible group. III: Evaluation of the effect of sex and body size-matching with special reference to obese
recipients. IV: Investigation of the association between donor and recipient age on early and late post-transplant
mortality.
Results: Study I: There was no difference in survival between identically and non-identically ABO matched
transplants. Study II: The incidence of death or retransplantation was higher for ABO-incompatible recipients. After
2005, the rate ABO-incompatible HTx in adults increased, likely due to planned ABO-incompatibility. For these
recipients, 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 influenced
predominantly early mortality, while recipient age influenced predominantly long-term mortality.
ABO-identical blood group matching has no survival benefit for AB recipients. ABO-incompatible heart
tranplantation may be feasible in carefully selected adult patients. Current weight matching guidelines can likely be
expanded for obese heart transplant recipients. Sex mismatch is a disadvantageous factor in heart
transplantation, not only in the context of size mismatch. Donor age appears to have a larger impact on early
mortality, likely due to a higher incidence of primary graft dysfunction. Recipient age appears to have a larger
impact 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
ISBN
978-91-7619-308-2
language
English
LU publication?
yes
id
0b6bd150-6e2f-49c7-b122-c79c76f7f13d
date added to LUP
2016-08-11 13:53:59
date last changed
2016-09-19 08:45:20
@phdthesis{0b6bd150-6e2f-49c7-b122-c79c76f7f13d,
  abstract     = {Heart transplantation (HTx) is severely limited by a shortage of donors. This thesis aimed to investigate the effect<br>
of variables used to match donors to recipients in HTx.<br>
Methods: Data from the ISHLT registry was used to study: I: Identical versus compatible non-identical ABOmatching<br>
in 3,589 AB HTx recipients. II: Outcomes of 94 ABO-incompatible transplants were compared to an<br>
ABO-compatible group. III: Evaluation of the effect of sex and body size-matching with special reference to obese<br>
recipients. IV: Investigation of the association between donor and recipient age on early and late post-transplant<br>
mortality.<br>
Results: Study I: There was no difference in survival between identically and non-identically ABO matched<br>
transplants. Study II: The incidence of death or retransplantation was higher for ABO-incompatible recipients. After<br>
2005, the rate ABO-incompatible HTx in adults increased, likely due to planned ABO-incompatibility. For these<br>
recipients, outcomes were similar to ABO-compatible recipients. Study III: Recipient-donor weight difference &gt;30%<br>
predicted mortality in non-obese but not obese recipients. Sex mismatched transplants had impaired survival.<br>
There was no modification of the association between size matching and mortality risk by sex matching. Study IV:<br>
Recipient and donor age was associated with both early and late mortality. However, donor age influenced<br>
predominantly early mortality, while recipient age influenced predominantly long-term mortality.<br>
ABO-identical blood group matching has no survival benefit for AB recipients. ABO-incompatible heart<br>
tranplantation may be feasible in carefully selected adult patients. Current weight matching guidelines can likely be<br>
expanded for obese heart transplant recipients. Sex mismatch is a disadvantageous factor in heart<br>
transplantation, not only in the context of size mismatch. Donor age appears to have a larger impact on early<br>
mortality, likely due to a higher incidence of primary graft dysfunction. Recipient age appears to have a larger<br>
impact on late mortality likely due to effects of immunosenescence.},
  author       = {Bergenfeldt, Henrik},
  isbn         = {978-91-7619-308-2},
  keyword      = {Heart Transplantation},
  language     = {eng},
  pages        = {92},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  title        = {Recipient and Donor Characteristics - Impact on Outcome after Heart Transplantation},
  year         = {2016},
}