The Annals of Thoracic Surgery, Vol 58, 1050-1053, Copyright © 1994 by The Society of Thoracic Surgeons
Cardiac transplant donor heart allocation based on prospective tissue matching
VJ DiSesa, R Mull, ES Daly, LH Edmunds Jr, DM Mancini and HJ Eisen
Department of Surgery, Medical College of Pennsylvania, Philadelphia.
The present priority scheme for the allocation of donor hearts based on
patient acuity and waiting time contributes to the escalating costs of
heart transplantation, ignores the potential outcome advantages of
prospective tissue matching, and is vulnerable to manipulation. Costs have
trebled in recent years, as recipients frequently spend weeks before
transplantation as inpatients in intensive care units and become more
susceptible to nosocomial complications. The findings from an international
cooperative study suggest that patient survival is correlated with the
level of histocompatibility (ie, human lymphocyte antigen [HLA]) matching.
We observed a similar inverse association between retrospective fortuitous
HLA matching and the risk of rejection in 39 patients undergoing heart
transplantation over a 29-month period (p = 0.03 by nonparametric
analysis). These observations prompted us to consider the feasibility of
donor heart allocation based on the degree of HLA matching and waiting time
alone. Current methods permit the accurate determination of HLA type in a
matter of hours using donor peripheral blood alone. Human lymphocyte
antigen typing, therefore, could be performed locally before organ
harvesting, making issues of donor heart preservation irrelevant. We
evaluated the extent of HLA matching that might be achieved practically.
Forty-seven patients on our waiting list during calendar year 1991 were
tested retrospectively for HLA matching with all geographically accessible
1991 heart donors identified by the United Network for Organ Sharing for
all donors from hospitals east of the Mississippi River.(ABSTRACT TRUNCATED
AT 250 WORDS)
