New French heart allocation system: Comparison with Eurotransplant and US allocation systems

Dorent, Richard; Jasseron, Carine; Audry, Benoît; Bayer, Florian; Legeai, Camille; Cantrelle, C.; Smits, Jacqueline M.; Eisen, Howard J.; Jacquelinet, Christian; Leprince, Pascal; Bastien, Olivier

doi:10.1111/ajt.15816

Cited by 45 publications

(53 citation statements)

References 10 publications

(10 reference statements)

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“…Our claim is that this flexible gravity model can be generalized to all organs and to different geographical context: indeed, it is used in France for heart 33,46‐48 and kidney 49,50 allocation schemes. Distance decays have also been calculated with a Poisson regression, based on observed data.…”

Section: Discussionmentioning

confidence: 99%

“…A major improvement added for heart transplants is calculation of the distance matrix 33 . Although distance between procurement centers and transplantation centers is still calculated in travel time by roads for the LAS, the heart allocation system is now calculated by travel time by roads if the distance is <200 km, otherwise by roads and private planes.…”

Section: Discussionmentioning

confidence: 99%

“…To choose the best balance, different distance functions have been tested on the Agence de la biomédecine simulation platform. This tool follows the same principles as UNOS Liver Allocation Model ‐ ULAM 30 and it has proven its effectiveness for organ allocation simulations 31‐33 . Organs reattributions were simulated based on historical data and outcomes were assessed on changes in deaths or withdrawals on the waiting list and in center activity.…”

Section: Methodsmentioning

confidence: 99%

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Removing administrative boundaries using a gravity model for a national liver allocation system

Bayer

Audry

Jasseron

et al. 2021

American Journal of Transplantation

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Geographic disparities emerged as an increasing issue in organ allocation policies. Because of the sequential and discrete geographical models used for allocation scores, artificial regional boundaries may impede the access of candidates with the greatest medical urgency to vital organs. This article describes a continuous geographical allocation model that provides accurate organ access by introducing a multiplicative interaction between the patient's condition and the distance to the graft by using a gravity model. Patients with the most urgent need will thus have access to organs from farther away, while those in less urgent need may only have access to organs geographically closer. Compared to the previous French liver allocation scheme, the gravity model precluded transplantations for candidates with a Model for End‐Stage Liver Disease (MELD) ≤ 14 for decompensated cirrhosis from 10.3% to 0.6%. Death and delisting while on the waiting list at 1 year also decreased from 30.1% to 22.4% for MELD ≥ 35. Waiting list (cumulative hazard ratio (CHR) 0.84 after adjustment) and posttransplant survival improved significantly (hazard ratio = 0.83 after adjustment). This new liver allocation system provides more equitable access to liver transplants and an efficient and safe alternative to administrative boundaries for geographical models in organ allocation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Removing administrative boundaries using a gravity model for a national liver allocation system

Bayer

Audry

Jasseron

et al. 2021

American Journal of Transplantation

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“…Prior studies have shown that non‐compliance of immunosuppression use may lead to increased mortality in younger recipients which we could not assess 24 . Moreover, decisions to accept or reject a donor are highly selective as disease severity of recipient likely influences the quality of a donor deemed acceptable and this can potentially introduce some bias 25 . This study looks at a population who were offered transplant and cannot take into account those who were declined.…”

Section: Discussionmentioning

confidence: 99%

Impact of age mismatch between donor and recipient on heart transplant mortality

Kumar

Bonnell

Prikis

et al. 2020

Clinical Transplantation

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The effect of donor‐to‐recipient (D‐R) age mismatch in adult heart transplant population is not clearly described, and we undertook this study to determine the impact of age mismatch on mortality. Heart transplant recipients from 2000 to 2017 were identified using the United Network of Organ Sharing database. The cohort was divided into three groups: donor age within 5 years of recipient age (Group 1), donors >5 years younger than recipient (group 2), and donors >5 years older than recipients (Group 3). We also evaluated if this finding changed by recipient age. Twenty eight thousand, four hundred and eleven patients met the inclusion criteria. Compared to group 1, the adjusted hazard ratio (aHR) for mortality for group 2 was 0.91 (0.83–0.99, p value <.039) and for group 3 was 1.36 (1.21–1.52, p value <.001); however, when looking at recipient age as continuous variable, receiving a younger heart was protective only for recipients younger than 45 years of age, and receiving a heart transplant from an older donor was detrimental only in recipients aged 25–35.

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“…Some allocation schemes, such as the French Heart Allocation System, include an individual scoring system aimed at stratifying the risk of early posttransplant death. In the French system, transplant is contraindicated if the risk of death in the first year after HTx is greater than 50% 9‐11 . The development of a heart allocation score is a priority for the next revision to the Organ Procurement and Transplantation Network (OPTN) heart allocation system, and a score based on survival benefit is the most equitable.…”

Section: Introductionmentioning

confidence: 99%

Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients

Coutance

Kransdorf

Bonnet

et al. 2021

American Journal of Transplantation

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Accurate risk stratification of early heart transplant failure is required to avoid futile transplants and rationalize donor selection. We aimed to evaluate the statistical performance of existing risk scores on a contemporary cohort of heart transplant recipients. After an exhaustive search, we identified 16 relevant risk scores. From the UNOS database, we selected all first noncombined adult heart transplants performed between 2014 and 2017 for validation. The primary endpoint was death or retransplant during the first year posttransplant. For all scores, we analyzed their association with outcomes, sensitivity, specificity, likelihood ratios, and discrimination (concordance index and overlap of individual scores). The cohort included 9396 patients. All scores were significantly associated with the primary outcome (P < .001 for all scores). Their likelihood ratios, both negative and positive, were poor. The discriminative performance of all scores was limited, with concordance index ranging from 0.544 to 0.646 (median 0.594) and an important overlap of individual scores between patients with or without the primary endpoint. Subgroup analyses revealed important variation in discrimination according to donor age, recipient age, and the type of assist device used at transplant. Our findings raise concerns about the use of currently available scores in the clinical field.

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New French heart allocation system: Comparison with Eurotransplant and US allocation systems

Cited by 45 publications

References 10 publications

Removing administrative boundaries using a gravity model for a national liver allocation system

Removing administrative boundaries using a gravity model for a national liver allocation system

Impact of age mismatch between donor and recipient on heart transplant mortality

Statistical performance of 16 posttransplant risk scores in a contemporary cohort of heart transplant recipients

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