Impact of new allocation system on length of stay following heart transplantation in the United States

Doulamis, Ilias P.; Gemelli, Marco; Rempakos, Athanasios; Tzani, Aspasia; Oh, Nicholas A.; Kampaktsis, Polydoros; Guariento, Alvise; Kuno, Toshiki; Alvarez, Paulino; Briasoulis, Alexandros

doi:10.1111/ctr.15114

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Older age comes along with more comorbidities, and in our analysis patients >70 years old had a significantly higher need of dialysis after HT. It is well known that elderly population has a higher incidence of chronic kidney disease (CKD) and this is confirmed by the fact that in our population there was a significantly higher creatinine in older patients 14,15 . A higher level of creatinine in the preoperative period could have led to an increased incidence of acute kidney injury in the post‐transplantation period, during which nephrotoxic drugs are used for the immunosuppression.…”

Section: Discussionsupporting

confidence: 73%

Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US

Gemelli,

Doulamis,

Addonizio

et al. 2024

Clinical Transplantation

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BackgroundUnited Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of patients on a ventricular assist device as a bridge to heart transplant and prioritize sicker people in anticipation of a heart graft. We aimed to assess the impact of patient age in the new allocation policy on mortality following heart transplantation. Secondary outcomes included the effect of age ≥70 on post‐transplant events, including stroke, dialysis, pacemaker, and rejection requiring treatment.MethodsThe UNOS Registry was queried to identify patients who underwent heart transplants alone in the US between 2000 and 2021. Patients were divided into groups according to their age (over 70 and under 70 years old).ResultsPatients aged over 70 were more likely to require dialysis during follow‐up, but less likely to experience rejection requiring treatment, compared with patients aged <70. Age ≥70 in the new allocation system was a significant predictor of 1‐year mortality (adjusted HR: 1.41; 95% CI: 1.05–1.91; p = .024), but its effect on 5‐year mortality was not significant after adjusting for potential confounders (adjusted HR: 1.27; 95% CI:.97–1.66; p = .077). Undergoing transplantation under the new allocation policy vs the old allocation policy was not a significant predictor of mortality in patients over 70 years old.ConclusionsAge ≥70 is a significant predictor of 1‐year mortality following heart transplantation, but not at 5 and 10 years; however, the new allocation does not seem to have changed the outcomes for this group of patients.

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Section: Discussionsupporting

confidence: 73%

Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US

Gemelli,

Doulamis,

Addonizio

et al. 2024

Clinical Transplantation

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“…Despite this, the risk of rejection is always present, and it seems to be particularly deleterious when it happens within the first year after transplantation [9,10]. Rejection after heart transplantation is a known predictor of later post-transplant morbidity and mortality and is one of the major causes of prolonged length of stay, readmissions, and increased costs for the health system [11][12][13]. One of the risks associated with the UNOS policy changes that could potentially lead to an increase in the rate of rejection is the more direct access to heart transplantation for higher-acuity patients.…”

Section: Introductionmentioning

confidence: 99%

Rejection Requiring Treatment within the First Year following Heart Transplantation: The UNOS Insight

Gemelli,

Doulamis,

Tzani

et al. 2023

JPM

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(1) Background: Heart failure is an extremely impactful health issue from both a social and quality-of-life point of view and the rate of patients with this condition is destined to rise in the next few years. Transplantation remains the mainstay of treatment for end-stage heart failure, but a shortage of organs represents a significant problem that prolongs time spent on the waiting list. In view of this, the selection of donor and recipient must be extremely meticulous, considering all factors that could predispose to organ failure. One of the main considerations regarding heart transplants is the risk of graft rejection and the need for immunosuppression therapy to mitigate that risk. In this study, we aimed to assess the characteristics of patients who need immunosuppression treatment for rejection within one year of heart transplantation and its impact on mid-term and long-term mortality. (2) Methods: The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent a heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for anti-rejection treatment within one year of heart transplantation. Patients’ characteristics in the two groups were assessed, and 1 year and 10 year mortality rates were compared. (3) Results: A total of 43,763 patients underwent isolated heart transplantation in the study period, and 9946 (22.7%) needed anti-rejection treatment in the first year. Patients who required treatment for rejection within one year after transplant were more frequently younger (49 ± 14 vs. 52 ± 14 years, p < 0.001), women (31% vs. 23%, p < 0.001), and had a higher CPRA value (14 ± 26 vs. 11 ± 23, p < 0.001). Also, the rate of prior cardiac surgery was more than double in this group (27% vs. 12%, p < 0.001), while prior LVAD (12% vs. 11%, p < 0.001) and IABP (10% vs. 9%, p < 0.01) were more frequent in patients who did not receive anti-rejection treatment in the first year. Finally, pre-transplantation creatinine was significantly higher in patients who did not need treatment for rejection in the first year (1.4 vs. 1.3, p < 0.01). Most patients who did not require anti-rejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplantation after the new allocation policy implementation (65% vs. 49%, p < 0.001). Patients who needed rejection treatment in the first year had a higher risk of unadjusted 1 year (HR: 2.25; 95% CI: 1.88–2.70; p < 0.001), 5 year (HR: 1.69; 95% CI: 1.60–1.79; p < 0.001), and 10 year (HR: 1.47; 95% CI: 1.41–1.54, p < 0.001) mortality, and this was confirmed at the adjusted analysis at all three time-points. (4) Conclusions: Medical treatment of acute rejection was associated with significantly increased 1 year mortality compared to patients who did not require anti-rejection therapy. The higher risk of mortality was confirmed at a 10 year follow-up. Further studies and newer follow-up data are required to investigate the role of anti-rejection therapy in the heart transplant population.

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Cardiac Rehabilitation to Inpatient Heart Transplant—HRN4HTx Intervention Protocol

Loureiro,

Parola,

Duarte

et al. 2024

Nursing Reports

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Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients’ functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials—NCT06552390.

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Impact of new allocation system on length of stay following heart transplantation in the United States

Cited by 3 publications

References 24 publications

Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US

Impact of age over 70 years in the new allocation system on the outcomes of heart transplantation in the US

Rejection Requiring Treatment within the First Year following Heart Transplantation: The UNOS Insight

Cardiac Rehabilitation to Inpatient Heart Transplant—HRN4HTx Intervention Protocol

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