OPTN/SRTR 2017 Annual Data Report: Heart

Colvin, Monica; Smith, Jodi M.; Hadley, N.; Skeans, M. A.; Uccellini, K.; Lehman, Rebecca R.; Robinson, A. M.; Israni, Ajay K.; Snyder, Jon J.; Kasiske, Bertram L.

doi:10.1111/ajt.15278

Cited by 124 publications

(114 citation statements)

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“…Currently, body size and blood group are not considered explicit criterion within the revised heart allocation system, even though these factors are known to impact wait time and rates of transplantation. An analysis of more than 25 000 HT listed patients from the UNOS database by Weiss et al demonstrated that patients with a BMI ≥30 kg/m 2 are likely to spend twice as long on the transplant WL as normal‐weight patients.…”

Section: Discussionmentioning

confidence: 99%

“…Covariates included in the models were age, sex, eGFR, BMI, and blood group. A stratified analysis by blood group (O blood group vs other blood groups) and BMI (<30 vs ≥30 kg/m 2 , cutoff chosen based on prior literature) was performed. Additionally, the corresponding cumulative incidence function curves were generated .…”

Section: Methodsmentioning

confidence: 99%

“…The new allocation system is projected to reduce overall WL mortality rates by increasing access to transplantation for the sickest patients . However, certain features that are known to affect WL outcomes are not accounted for in the current system, including body size and blood group . Additionally, since the outcome simulations were performed using national‐level data, whether the revised system accurately prioritizes the most acute patients at the level of a single center has not yet been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Validating patient prioritization in the 2018 Revised United Network for Organ Sharing Heart Allocation System: A single‐center experience

Nayak

Dong

et al. 2020

Clinical Transplantation

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The 2018 Revised United Network for Organ Sharing Heart Allocation System (HAS) was proposed to reclassify status 1A candidates into groups of decreasing acuity; however, it does not take into account factors such as body mass index (BMI) and blood group which influence waitlist (WL) outcomes. We sought to validate patient prioritization in the new HAS at our center. We retrospectively evaluated patients listed for heart transplantation (n = 214) at Emory University Hospital from 2011 to 2017. Patients were reclassified into the 6‐tier HAS. Multistate modeling and competing risk analysis were used to compare outcomes of transplantation and WL death/deterioration between new tiers. Additionally, a stratified sensitivity analysis by BMI and blood group was performed. Compared with tier 4 patients, there was progressively increasing hazard of WL death/deterioration in tier 3 (HR: 2.52, 95% CI: 1.37‐4.63, P = .003) and tier 2 (HR: 5.03, 95% CI: 1.99‐12.70, P < .001), without a difference in transplantation outcome. When stratified by BMI and blood group, this hierarchical association was not valid in patients with BMI ≥30 kg/m2 and non‐O blood groups in our cohort. Therefore, the 2018 HAS accurately prioritizes the sickest patients in our cohort. Factors such as BMI and blood group influence this relationship and iterate that the system can be further refined.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validating patient prioritization in the 2018 Revised United Network for Organ Sharing Heart Allocation System: A single‐center experience

Nayak

Dong

et al. 2020

Clinical Transplantation

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“…These findings are similar to national data on the cumulative incidence of death in heart and lung transplant recipients, which increases over time in the 5‐year post‐transplant period. Based on the primary cause of death reported by the Organ Procurement and Transplantation Network follow‐ups, infection is the second most common cause of death after graft failure …”

Section: Discussionmentioning

confidence: 99%

Sepsis outcomes in solid organ transplant recipients

Gotur

Masud

Ezeana

et al. 2019

Transplant Infectious Dis

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Background We present data on a cohort of patients diagnosed with sepsis over a 10‐year period comparing outcomes in solid organ transplant (SOT) and non–solid organ transplant (non–SOT) recipients. Methods This is a retrospective single‐center study of patients with diagnosis of sepsis from 1/1/06 to 6/30/16. Cases and controls were matched by year of sepsis diagnosis with propensity score matching. Conditional logistic regression and repeated measurement models were performed for binary outcomes. Trends over time for in‐hospital mortality were determined using the Cochran‐Armitage test. A gamma‐distributed model was performed on the continuous variables. Results Overall, there were 18 632 admission encounters with a discharge diagnosis of sepsis in 14 780 unique patients. Of those admissions, 1689 were SOT recipients. After 1:1 matching by year, there were three thousand three hundred and forty patients (1670 cases; 1670 controls) diagnosed with sepsis. There was a decreasing trend for in‐hospital mortality for sepsis over time in SOT patients and non–SOT patients (P < .05) due to early sepsis recognition and improved standard of care. Despite higher comorbidities in the SOT group, conditional logistic regression showed that in‐hospital mortality for sepsis in SOT patients was similar compared with non–SOT patients (odds ratio [OR] =1.14 [95% confidence interval {CI}, 0.95‐1.37], P = .161). However, heart and lung SOT subgroups had higher odds of dying compared with the non–SOT group (OR = 1.83 [95% CI, 1.30‐2.57], P < .001 and OR = 1.77 [95% CI, 1.34‐2.34], P < .001). On average, SOT patients had 2 days longer hospital length of stay compared with non–SOT admissions (17.00 ± 19.54 vs 15.23 ± 17.07, P < .05). Additionally, SOT patients had higher odds of hospital readmission within 30 days (OR = 1.25 [95% CI, 1.06‐1.51], P = .020), and higher odds for DIC compared with non–SOT patients (OR = 1.76 [95% CI, 1.10‐2.86], P = .021). Conclusion Sepsis in solid organ transplants and non–solid organ transplant patients have similar mortality; however, the subset of heart and lung transplant recipients with sepsis has a higher rate of mortality compared with the non–solid organ transplant recipients. SOT with sepsis as a group has a higher hospital readmission rate compared with non–transplant sepsis patients.

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“…Cardiac transplantation remains the gold standard therapy for a small number of highly selected patients with symptomatic end‐stage heart failure . In 2017, 3529 new candidates were listed for heart transplantation in the USA but only 2841 patients were transplanted . Approximately 27% of all patients listed for transplantation will either die or become inactive on the transplant list at 2 y .…”

Section: Introductionmentioning

confidence: 99%