Evaluation of Case Volumes of a Heart Transplant Program and Short-term Outcomes After Changes in the United Network for Organ Sharing Donor Heart Allocation System

Mori, Makoto; Wilson, Lynn; Ali, Ayyaz; Ahmad, Tariq; Anwer, Muhammad; Jacoby, Daniel; Geirsson, Arnar; Krumholz, Harlan M.

doi:10.1001/jamanetworkopen.2020.17513

Cited by 16 publications

(27 citation statements)

References 11 publications

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“…Similar to our findings, several studies demonstrate increased ischemic time and decreased waitlist time in the postchange era 27–32 . Some studies suggest that the new system is protective against waitlist mortality 28,30 .…”

Section: Discussionsupporting

confidence: 91%

“…Conversely, a study of 3032 heart transplant recipients in the postchange era showed no difference in waitlist mortality 31 . In the postchange era, the use of temporary MCS devices occurs more frequently than durable left ventricular assist devices as a bridge to transplantation 27–32 . Temporary MCS devices are associated with an increased risk for mortality after transplantation, thereby provoking concern for consequential survival outcomes 33–35 .…”

Section: Discussionmentioning

confidence: 99%

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Impact of increased donor distances following adult heart allocation system changes: A single center review of 1‐year outcomes

Hoffman

Larson

Rahaman

et al. 2021

Journal of Cardiac Surgery

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Background: On October 18, 2018, several changes to the donor heart allocation system were enacted. We hypothesize that patients undergoing orthotopic heart transplantation (OHT) under the new allocation system will see an increase in ischemic times, rates of primary graft dysfunction, and 1-year mortality due to these changes.Methods: In this single-center retrospective study, we reviewed the charts of all OHT patients from October 2017 through October 2019. Pre-and postallocation recipient demographics were compared. Survival analysis was performed using the Kaplan-Meier method.Results: A total of 184 patients underwent OHT. Recipient demographics were similar between cohorts. The average distance from donor increased by more than 150 km (p = .006). Patients in the postallocation change cohort demonstrated a significant increase in the rate of severe left ventricle primary graft dysfunction from 5.4% to 18.7% (p = .005). There were no statistically significant differences in 30-day mortality or 1-year survival. Time on the waitlist was reduced from 203.8 to 103.7 days (p = .006).Conclusions: Changes in heart allocation resulted in shorter waitlist times at the expense of longer donor distances and ischemic times, with an associated negative impact on early post-transplantation outcomes. No significant differences in 30-day or 1-year mortality were observed.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Impact of increased donor distances following adult heart allocation system changes: A single center review of 1‐year outcomes

Hoffman

Larson

Rahaman

et al. 2021

Journal of Cardiac Surgery

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“…In fact, over 50% of donor hearts offered in the United States are rejected for OHT 19 . Donor hearts with unclear acceptability patterns tend to be outside of the traditionally accepted donor criteria but may still be potentially suitable for transplantation 3 . Furthermore, considering that centers with more aggressive donor acceptance rates have been shown to have superior post-OHT outcomes when compared to centers with lower volumes 20 , uncertainty exists as to if there is a volume-relationship between the use of ECDs in OHT and if an association exists between ECD recipient's outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac transplantation remains the gold standard treatment for end stage heart failure 1 , and despite the growing prevalence of advanced heart failure in the United States, donor heart supply critically limits rates of OHT 2 . This supply and demand mismatch is magnified by the fact that over 50% of offered donor hearts are not accepted for transplantation 3 . The reduced utilization of certain donor hearts is largely tied to the practice of rejecting organs that fall outside of strict donor selection criteria.…”

Section: Introductionmentioning

confidence: 99%

Impact of Center Donor Acceptance Patterns on Utilization of Extended-Criteria Donors and Outcomes

Hess

Seese

Sultan

et al. 2021

Preprint

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Background: This study investigated the impact of transplanting center donor acceptance patterns on usage of extended-criteria donors (ECDs) and posttransplant outcomes following orthotopic heart transplantation (OHT). Methods: The Scientific Registry of Transplant Recipients was queried to identify heart donor offers and adult, isolated OHT recipients in the United States from 1/1/2013-10/17/2018. Centers were stratified into 3 equal-size terciles based on donor heart acceptance rates (<13.7%, 13.7%-20.2%, >20.2%). Overall survival was compared between recipients of ECDs (≥40 years, left ventricular ejection fraction <60%, distance ≥500 miles, hepatitis B, hepatitis C or human immunodeficiency virus, or ≥50 offers) and recipients of traditional-criteria donors, and among transplanting terciles. Results: A total of 85,505 donor heart offers were made to 133 centers with 15,264 (17.9%) accepted for OHT. High-acceptance programs (>20.2%) more frequently accepted donors with LVEF <60%, HIV, HCV, and/or HBV, ≥50 offers, or distance >500 miles from the transplanting center (each p<0.001). Posttransplant survival was comparable across all three terciles (p=0.11). One- and five-year survival were also similar across terciles when examining recipients of all five ECD factors. Acceptance tier and increasing acceptance rate were not found to have any impact on mortality in multivariable modeling. Of ECD factors, only age ≥40 years was found to have increased hazards for mortality (HR 1.33, 95% CI 1.22-1.46, p<0.001). Conclusions: Of recipients of ECD hearts, outcomes are similar across center-acceptance terciles. Educating less aggressive programs to increase donor acceptance and ECD utilization may yield higher national rates of OHT without major impact on outcomes.

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“… 27 - 29 For example, the group from Yale University recently reported dramatic increases in their program volume by accepting older donors, and by prioritizing temporary mechanical circulatory support. 30 …”

mentioning

confidence: 99%

Better Is the Enemy of Good: Ever-changing Heart Transplant Allocation

Baran

2020

Transplantation Direct

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Evaluation of Case Volumes of a Heart Transplant Program and Short-term Outcomes After Changes in the United Network for Organ Sharing Donor Heart Allocation System

Cited by 16 publications

References 11 publications

Impact of increased donor distances following adult heart allocation system changes: A single center review of 1‐year outcomes

Impact of increased donor distances following adult heart allocation system changes: A single center review of 1‐year outcomes

Impact of Center Donor Acceptance Patterns on Utilization of Extended-Criteria Donors and Outcomes

Better Is the Enemy of Good: Ever-changing Heart Transplant Allocation

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