Background. On 11/22/10, an ABO-incompatible (ABO-i) pediatric (ped) heart (HR) policy was implemented. This policy allows Status 1A/1B ped candidates <2 yrs at listing who meet the eligibility requirements to accept a HR of any blood type. Anti-A/anti-B titers must be reported while listed, at transplant (tx), and in the event of graft loss or death within 1 yr of tx. This analysis was conducted as part of policy evaluation for the OPTN Pediatric Transplantation Committee.

Data and Methods. The OPTN database was used to identify waiting list (WL) cohorts for Status 1A/1B registrations (regs) <2 yrs at listing added to the HR alone WL during 17 mos post-policy (11/22/10-4/21/12) and regs still waiting on 6/30/12 in Status 1A/1B. Blood type AB regs were excluded from these analyses. The OPTN database was also analyzed for Status 1A/1B ABO-i HR alone txs during 11/22/10-4/21/12 for pre- and post-tx titer information and post-tx outcomes. Patient (pt) survival was computed using the Kaplan-Meier method.

Results. 99 (36%) of the 278 Status 1A/1B regs added to the HR alone WL at <2 yrs at listing indicated a willingness to accept an ABO-i HR at listing. Of these, 87% were listed as Status 1A. Of the 26 regs still waiting on 6/30/12, 10 (39%) currently indicated a willingness to accept an ABO-i HR, but none of the regs listed at 1-<2 yrs indicated a willingness to accept an ABO-i HR. Of the 20 ABO-i txs during 11/22/10-4/21/12, 19 were performed in Status 1A recipients (recips) <1 yr at both listing and tx, while 1 ABO-i tx was performed in a Status 1B recip 1-<2 yrs at both listing and tx. Pt survival ranged from 9 to 376 days, with 2 recips reported to have died. One recip died 51 days post-tx of CVA causes and had a titer value of 1:2 at the time of death. The other recip died 209 days post-tx due to cardiovascular causes and had a titer value of 1:1 at the time of death. Six-month pt survival for ABO-i recips was comparable to that for ABO identical/compatible recips (94% vs. 90%, p=0.56).

Conclusions. Early results of ABO-i HR txs mostly performed in ped recips <1 yr suggest comparable pt survival with ABO identical/compatible txs and supports ABO-i txs in infants. More data in the 1-<2 yr group are needed. Long-term survival and secondary outcomes also need to be examined as more ABO-i txs and follow-up information are available.

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