Effect of ABO blood type on survival of heart transplant patients treated with cyclosporine

We conducted a retrospective analysis of how ABO blood type matching affects the survival rate of heart transplant recipients. The study included 189 patients treated with cyclosporine who had heart transplantations at the Texas Heart Institute, Houston, between July 1982 and June 1987. There were 78 patients with blood type A, 28 with type B, five with type AB, and 78 with type O. Therefore, 33 patients had B antigen (types B and AB), and 156 lacked B antigen (types A and O). Of the 189 patients, 152 received ABO identical hearts and 37 received ABO nonidentical hearts from donors with compatible blood types. The 1-year graft survival for patients with B antigen was 66.7% compared with 78.1% for those without B antigen (p less than 0.05). More patients in the B antigen group, however, had transplantations with ABO nonidentical hearts. Patients with type O blood had the best 1-year survival (80.7%). Recipients of ABO identical donor hearts had a better graft survival than those with ABO nonidentical donor hearts: for type A patients, survival was 78.5% and 64.7%, respectively; for type B patients, survival was 75.0% and 62.5%, respectively. The 1-year survival was better for the patients with ABO identical hearts (79.5%) than for those with ABO nonidentical hearts (62.2%, p less than 0.01). The incidence of fatal rejection in ABO nonidentical hearts was higher than in ABO identical hearts (13.5% versus 2.6%, p less than 0.05). Over the last 6 years we have used various criteria for recipient and donor selection and for determining which immunosuppressive regimens are most effective. From this series of patients we believe that ABO identical matching of heart transplant recipients and donors improves the long-term survival rate.