Geographic Variation in US Heart Transplant Outcomes  and Consequences for Health Care Equity

Masha, Luke

doi:10.1001/jamanetworkopen.2020.28856

Cited by 4 publications

(8 citation statements)

References 7 publications

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“…Under this concept, the distance between the donor and transplant hospital is part of a composite score, which also includes the medical acuity of the waitlisted patient and the biologic match with the donor [29 & ]. Geographic disparities affecting heart tation include heterogeneity in regional donor availability [30,31], distance traveled impacting graft ischemic time (Fig. 4) [30,32,33], and local socioeconomic disparities [30,34] including access to care.…”

Section: Geographic Disparities In Lung and Heart Transplantationmentioning

confidence: 99%

“…Geographic disparities affecting heart tation include heterogeneity in regional donor availability [30,31], distance traveled impacting graft ischemic time (Fig. 4) [30,32,33], and local socioeconomic disparities [30,34] including access to care. Studies have shown that the number of transplant centers vary per state [30,35] affecting both waitlist mortality and rate of transplantation even after adjusting for recipient acuity of illness [35].…”

Section: Geographic Disparities In Lung and Heart Transplantationmentioning

confidence: 99%

“…4) [30,32,33], and local socioeconomic disparities [30,34] including access to care. Studies have shown that the number of transplant centers vary per state [30,35] affecting both waitlist mortality and rate of transplantation even after adjusting for recipient acuity of illness [35]. Similar to the revision in lung allocation, in October 2018, the heart transplant allocation policy was revised to reduce waitlist mortality and geographical disparities as the former allocation scheme prioritizing patients living within the DSA violated the OPTN's Final Rule, which states transplant 'shall not be based on the candidate's place of residence or place of listing.…”

Section: Geographic Disparities In Lung and Heart Transplantationmentioning

confidence: 99%

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Disparities in heart and lung transplantation

Tsuang

Khedraki

Hsich

2021

Current Opinion in Organ Transplantation

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Purpose of review Cardiothoracic transplantation is the definitive therapy for end-stage heart and lung disease. In service to this population, disparities in access and care must be simultaneously understood and addressed. Recent findings There are sex, race, geographic, age, and underlying disease disparities in both heart and lung transplantation. Women have reduced waitlist survival but improved posttransplant survival when compared with men for both heart and lung transplantation. Black patients have worse outcome compared with other races postheart transplant. Geographic disparities impact the likelihood of receiving heart or lung transplant and the growing number of patients with advanced age seeking transplant complicates discussions on survival benefit. Finally, underlying disease has affected outcomes for both heart and lung transplant and now are incorporated into the allocation system. Summary Though heart and lung transplantation have several existing disparities, it remains to be seen how advancements in medical technology, changes in donor organ allocation policies, and growing experience in patient selection will impact these concerns.

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Section: Geographic Disparities In Lung and Heart Transplantationmentioning

confidence: 99%

Section: Geographic Disparities In Lung and Heart Transplantationmentioning

confidence: 99%

Section: Geographic Disparities In Lung and Heart Transplantationmentioning

confidence: 99%

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Disparities in heart and lung transplantation

Tsuang

Khedraki

Hsich

2021

Current Opinion in Organ Transplantation

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“…Heart transplantation (HTx) is the gold standard for the treatment of terminal heart failure that is refractory to conventional medical treatment [ 1 ]. Although the procedure is effective, chronic rejection and cardiac allograft vasculopathy (CAV) still continue to limit the long-term success of HTx (1-year and 10-year survival of 85% and 60%, respectively) [ 1 , 2 , 3 , 4 ]. Thus, novel diagnostic and prognostic tools for the long-term monitoring of HTx patients at risk of developing allograft vasculopathy are needed.…”

Section: Introductionmentioning

confidence: 99%

Nailfold Videocapillaroscopy for Non-Invasive Assessment of Microcirculation and Prognostic Correlation with Endothelial Dysfunction, Cardiovascular Risk Factors, and Non-HLA Antibodies in Heart Transplant Recipients: A Pilot Study

Sikorska

Kamińska

Catar

et al. 2023

JCM

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Early identification of allograft vasculopathy and the concomitant elimination of adverse risk factors is essential for improving the long-term prognosis of heart transplant (HTx) recipients with underlying cardiovascular disease (CVD). The major aim of this pilot study was to conduct a non-invasive imaging evaluation of the HTx patient microcirculation by employing nailfold video-capillaroscopy (NVC) in a well-characterized patient and control cohort, and to correlate these data with endothelial cell function, accompanied by studies of traditional cardiovascular risk factors and non-HLA antibodies in HTx recipients. Ten patients undergoing HTx (mean age of 38 ± 14 years) were recruited for the study and compared to a control group of 12 well-matched healthy volunteers (mean age 35 ± 5 years) with normal body mass index (BMI). Detailed medical records were collected from all individuals. NVC was performed using CapillaryScope 200 MEDL4N microscope. For functional readout and correlation analysis, endothelial cell network formation in conjunction with measurements of patient serum levels of vascular endothelial growth factor (VEGF) and non-HLA autoantibodies directed against the angiotensin II type-1-receptor (anti-AT1R-Ab), endothelin-1 type-A-receptor (anti-ETAR-Ab), protease-activated receptor-1 (anti-PAR-1-Ab), and VEGF-A (anti-VEGF-A-Ab) were studied. Our NVC analysis found that the average apical loop diameter of nailfold capillaries was significantly increased in HTx recipients (p = 0.001). In addition, HTx patients with more prominent changes in capillaroscopic patterns were characterized by the presence of traditional cardiovascular risk factors, and HTx patients had increased levels of anti-AT1R-ab, anti-ETAR-ab, and anti-VEGF-A-Ab (p = 0.017, p = 0.025, and p = 0.003, respectively). Capillary diameters most strongly correlated with elevated serum levels of troponin T and triglycerides (R = 0.69, p = 0.028 and R = 0.81, p = 0.004, respectively). In conclusion, we found that an abnormal NVC pattern in HTx patients is associated with traditional CVD risk factors and that NVC is a useful non-invasive tool to conveniently monitor changes in the microvasculature of HTx patients.

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“…Heart transplantation (HTx) is considered a standard therapy for patients with end-stage heart failure refractory to medical treatment. Currently, the one-year and 10-year survival is around 85% and 60%, respectively, thus calling for further improvements in short-and long-term outcomes (1). The number of patients with end-stage heart failure is increasing, while the limited number of available donor organs is still a major limiting factor to the broader applicability of HTx (2).…”

Section: Introductionmentioning

confidence: 99%