Transplant Volume Is Associated With Graft Acceptance Threshold and Center Resource Availability

Chen, Carol W.; Auvil, Bryan; Zhang, Jason C.; Chung, Jennifer J.; Gaffey, Ann C.; Bermúdez, C.; Goldberg, Lee R.; Acker, Michael A.; Atluri, Pavan

doi:10.1016/j.cardfail.2019.03.009

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…We also found that low-volume centers had a lower frequency of donors from hypertensives and smokers, which is consistent with findings in the literature that highvolume centers are more likely to use higher risk donors. 8,13 It is possible that lower volume centers have more stringent donor heart requirements contributing to the discrepancy in waitlist times noted in our study. Programs with stricter allograft criteria are found to have increased waitlist mortality and higher rates of delisting due to condition deterioration.…”

Section: Discussionmentioning

confidence: 86%

Heart Transplant Waitlist Outcomes and Wait Time by Center Volume in the Pre-2018 Allocation Change Era

et al. 2023

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Although the transplant outcomes of centers are heavily monitored and compared, with a particular link between posttransplant outcomes and center volume demonstrated, little data exist comparing waitlist outcomes. Here, we explored waitlist outcomes by transplant center volume. We performed a retrospective analysis of adults listed for primary heart transplantation (HTx) from 2008 to 2018 using the United Network for Organ Sharing database. Transplant centers were split into low (<10 HTx/year), medium (10-30 HTx/year), and high (>30 HTx/year) volume, and waitlist outcomes were compared. Of the 35,190 patients included in our study, 23,726 (67.4%) underwent HTx, 4,915 (14.0%) died or deteriorated before receiving HTx, 1,356 (3.9%) were delisted due to recovery, and 1,336 (3.8%) underwent left ventricular assist device (LVAD) implantation. High-volume centers had higher rates of survival to transplant (71.3% vs. 60.6% for low-volume centers and 64.9% for medium-volume centers), and low rates of death or deterioration (12.6% vs. 14.6% for low-volume centers and 15.1% for medium-volume centers). Listing at a low-volume center was independently associated with death or delisting before HTx (HR 1.18, p = 0.007), whereas listing at a high-volume center (HR 0.86; p < 0.001) and prelisting LVAD (HR 0.67, p < 0.001) were protective. Death or delisting before HTx was lowest for patients listed in higher volume centers.

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Section: Discussionmentioning

confidence: 86%

Heart Transplant Waitlist Outcomes and Wait Time by Center Volume in the Pre-2018 Allocation Change Era

et al. 2023

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“…22,24 A DSRI could be employed to improve allocation of marginal hearts to high-volume centers where they are more likely to be accepted while maintaining clinically equivalent outcomes. 8,9,25 Ensuring marginal hearts go to high-volume center would thus increase the likelihood the hearts are used and effectively increase the size of the donor pool. This would, in theory, help reduce long waitlist times, which have been associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there is significant regional variability in heart donor acceptance, waitlist time, and post‐transplantation outcomes even after UNOS enacted policies meant to decrease these inequities 22,24 . A DSRI could be employed to improve allocation of marginal hearts to high‐volume centers where they are more likely to be accepted while maintaining clinically equivalent outcomes 8,9,25 . Ensuring marginal hearts go to high‐volume center would thus increase the likelihood the hearts are used and effectively increase the size of the donor pool.…”

Section: Discussionmentioning

confidence: 99%

“…We also aim to show how the heart DSRI could be used to characterize the relationship between allograft discard and recipient mortality. The DSRI could also be used to identify aggressive transplant centers that tend to utilize higher discard‐risk grafts without compromising patient outcomes 8,9 …”

Section: Introductionmentioning

confidence: 99%

“…The DSRI could also be used to identify aggressive transplant centers that tend to utilize higher discard-risk grafts without compromising patient outcomes. 8,9…”

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confidence: 99%

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Allograft discard risk index for heart transplantation

Reul

Saleem

Keller

et al. 2021

Clinical Transplantation

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Background:The numberof patients awaiting heart transplantation (HTx) substantially exceeds the number of donor hearts transplanted each year, yet nearly 65% of eligible donor hearts are discarded rather than transplanted. Methods: Deceased organ donors listed within the UNOS Deceased Donor Database between 2010 and 2020 were reviewed. Those greater than 10 years old and consented for heart donation were included and randomly separated into training (n = 48 435) and validation (n = 24 217) cohorts. A discard risk index (DSRI) was created using the results of univariable and multivariable analyses. Discard data were assessed at DSRI value deciles, and stratum-specific likelihood ratio (SSLR) analysis and Kaplan-Meier survival function were used for mortality data. Results: Factors associated with higher DSRI values included donor age > 45, LVEF, HBV-core antibodies, hypertension, and diabetes. The DSRI C-statistic was .906 in the training cohort and .904 in the validation cohort. The DSRI did not reliably predict 30day or 1-year mortality after transplantation (C-statistic .539 and .532, respectively). Conclusions:The factors leading to heart allograft discard are not correlated to the same degree with post-transplant outcomes. This suggests that optimizing utilization of certain allografts with slightly higher risk of discard could increase the heart donor pool with limited impact on posttransplant mortality. K E Y W O R D Sdeceased, donors and donation, donation after brain death (DBD), donor evaluation, organ acceptance, risk assessment/risk stratification INTRODUCTIONOrthotopic heart transplantation (HTx) exists as a crucial therapy for patients with end-stage heart disease. While the number of HTxs performed annually has increased over the last 2 decades, the number of patients on the waiting list also continues to grow. 1 Heart transplantation is limited by the availability of deceased donor heart allografts, yet a high proportion of potential donor hearts are discarded rather than transplanted. 2 Finding ways to bridge the gap between the supply and demand for donor hearts is of critical importance,

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Cardiac Donor Evaluation

Milano,

Chiang

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Transplant Volume Is Associated With Graft Acceptance Threshold and Center Resource Availability

Cited by 6 publications

References 7 publications

Heart Transplant Waitlist Outcomes and Wait Time by Center Volume in the Pre-2018 Allocation Change Era

Heart Transplant Waitlist Outcomes and Wait Time by Center Volume in the Pre-2018 Allocation Change Era

Allograft discard risk index for heart transplantation

Cardiac Donor Evaluation

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