Recipient and Donor Characteristics - Impact on Outcome after Heart Transplantation

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.