Specific ABO blood type and ABO compatibility versus identity each have a significant impact on graft survival. The use of ABO mismatched incompatible donors results in hyperacute rejection and early graft loss as with other organs.21 Early studies from the group in South Africa suggested a reduction in long-term survival for non-O recipients, particularly those with blood type B.22 This was supported by the Texas Heart Institute who also demonstrated up to a 20-30% reduction in long-term survival with the use of nonidentical donors.23 However, this was not confirmed by the Stanford group.24 Recent studies from the Cardiac Transplant Research Database25 have again shown reduced one-year survival for non-O identical and for all nonidentical donor-recipient matches. The one-year survival for blood group O identical matches was 88%, compared with 81% for ABO compatible matches (O donor into A or B recipient), 85% for blood group A identical matches, and 78% for blood group B identical matches. Based on these data, we have attempted to use only ABO identical donor-recipient matches except for critically ill patients. These results and the prolonged waiting time for blood group O recipients, have recently prompted UNOS to alter their allocation scheme for heart donors within each status category. Blood group O donors may be allocated only to O or B recipients, A donors only to A or AB recipients, and B donors only to B or AB recipients within each clinical status category.
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