Abo compatibility in lung transplantation
Demos D, Divine G, Paone G, Borgi J, Morgan J, Allenspach L, Stagner L, and Nemeh H. Abo compatibility in lung transplantation. J Heart Lung Transplant 2016; 35(4):S368.
J Heart Lung Transplant
Lung transplantation (LT) remains the only definitive treatment for end-stage lung disease (ESLD) refractory to medical therapy. The necessity for an identical blood-type (ABO) match for optimal outcome is controversial. Recent studies have demonstrated equivalent outcomes between ABO identical and compatible LT, but do not differentiate any individual ABO combinations. The purpose of this study was to evaluate whether certain ABO compatible combinations affect outcomes in LT. Methods: Observational analysis of the United Network for Organ Sharing (UNOS) database for adult Double LT (DLT) recipients from May 2005 to September 2014 was performed. Results: Of 9615 DLT, 8941 (93%) were ABO “identical”, with 2347 (26%) of those having A-subtype differences. 674 (7%) compatible patients included 415 (62%) with donor O and recipient A, 93 (14%) with donor O and recipient B, and 84 (12%) donor B and recipient AB. The remaining 72 (11%) patients included multiple combinations and were placed into a single group due to the small number of patients in each subgroup (ABO Compat Oth). ABO compatibility status was not associated with either bronchiolitis obliterans syndrome (BOS, p= 0.389) or overall mortality (p= 0.333) in multivariate analysis. Recipients in the ABO Compat Oth group had a higher risk of acute rejection (HR 1.44, 95% CI 1.05-1.97, p= 0.023), but showed no increased risk of BOS (p= 1.0) or mortality (p= 0.826). The other groups showed no association with acute rejection, though the AB-B group trended toward significantly less risk for rejection (HR 0.69, 95% CI 0.47-1.03, p= 0.07).Conclusion: Our results agree with recent findings in ABO compatibility and LT, and do not show negative effect on the short or long term outcome when the different subgroups are analyzed. In light of these findings, the lung allocation system could potentially be changed to consider the identical and compatible blood group combinations as the same to give patients with higher LAS a better chance at a shorter wait time.