TY - JOUR
T1 - Cardiac transplantation with increased-risk donors
T2 - Trends and clinical outcomes
AU - Manjunath, Anusha
AU - Maning, Jennifer
AU - Wu, Tingquing
AU - Bryner, Benjamin
AU - Harap, Rebecca
AU - Ghafourian, Kambiz
AU - Oputa, Olisemeka
AU - Pham, Duc T.
AU - Rasberry, Kiersten
AU - Raza, Yasmin
AU - Tibrewala, Anjan
AU - Wilcox, Jane
AU - Youmans, Quentin R.
AU - Okwuosa, Ike S.
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2025/2/15
Y1 - 2025/2/15
N2 - Background: Orthotopic Heart transplantation (OHT) is a definitive treatment for patients with advanced heart failure. Despite available evidence, recipients and some clinicians remain hesitant to accept organs from Increased Risk Donors (IRD). This study aims to report trends in acceptance of donors from IRD donors and long-term outcomes. Methods: This study is an analysis of OHT recipients captured in the United Network of Organ Sharing (UNOS) registry from 2004 to 2021. OHT recipients were dichotomized by IRD status. Primary objectives were to report survival following OHT and trends in IRD use. Secondary objectives included all-cause hospitalizations, hospitalizations for infection, treated rejection, and graft failure. Results: Of the 36,989 OHT recipients within the study period, 7779 (21%) were identified as recipients of IRD. Recipients of IRD were older (57 years vs 56 years, p ≤0.001), more likely to be African American (23% vs 21%, p = 0.006), blood group O (40% vs 38%, p = 0.02), have public insurance (52% vs 50%, p = 0.02), and have a BMI >30 (30% vs 29%, p = 0.003). IRD recipients had shorter waitlist time (69 days vs 76 days, p = 0.009) and similar long-term survival. IRD recipients also had lower odds of rehospitalization due to infection (OR 0.893, CI 0.842–0.947; p = 0.0002) and lower odds of rehospitalization due to rejection (OR 0.849, CI 0.782–0.921; p ≤0.001). Conclusions: In this large multicenter study, we report that recipients of IRD had similar long-term survival and incidence of graft failure as recipients of standard risk donors. Further analysis is needed to understand observed differences in outcomes of hospitalizations for infection and treated rejection.
AB - Background: Orthotopic Heart transplantation (OHT) is a definitive treatment for patients with advanced heart failure. Despite available evidence, recipients and some clinicians remain hesitant to accept organs from Increased Risk Donors (IRD). This study aims to report trends in acceptance of donors from IRD donors and long-term outcomes. Methods: This study is an analysis of OHT recipients captured in the United Network of Organ Sharing (UNOS) registry from 2004 to 2021. OHT recipients were dichotomized by IRD status. Primary objectives were to report survival following OHT and trends in IRD use. Secondary objectives included all-cause hospitalizations, hospitalizations for infection, treated rejection, and graft failure. Results: Of the 36,989 OHT recipients within the study period, 7779 (21%) were identified as recipients of IRD. Recipients of IRD were older (57 years vs 56 years, p ≤0.001), more likely to be African American (23% vs 21%, p = 0.006), blood group O (40% vs 38%, p = 0.02), have public insurance (52% vs 50%, p = 0.02), and have a BMI >30 (30% vs 29%, p = 0.003). IRD recipients had shorter waitlist time (69 days vs 76 days, p = 0.009) and similar long-term survival. IRD recipients also had lower odds of rehospitalization due to infection (OR 0.893, CI 0.842–0.947; p = 0.0002) and lower odds of rehospitalization due to rejection (OR 0.849, CI 0.782–0.921; p ≤0.001). Conclusions: In this large multicenter study, we report that recipients of IRD had similar long-term survival and incidence of graft failure as recipients of standard risk donors. Further analysis is needed to understand observed differences in outcomes of hospitalizations for infection and treated rejection.
KW - High risk donors
KW - Increased risk donors
KW - Orthotopic heart transplant
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U2 - 10.1016/j.ijcard.2024.132887
DO - 10.1016/j.ijcard.2024.132887
M3 - Article
C2 - 39662750
AN - SCOPUS:85211988170
SN - 0167-5273
VL - 421
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132887
ER -