OPTN/SRTR 2019 Annual Data Report: Heart

Abstract

The new adult heart allocation policy was approved in 2016 and implemented in October 2018. This year's Annual Data Report provides early insight into the effects of this policy. In 2019, new listings continued to increase, with 4086 new candidates. Also in 2019, 3597 heart transplants were performed, an increase of 157 (4.6%) from 2018; 509 transplants occurred in children and 3088 in adults. Short‐ and long‐term posttransplant mortality rates improved. Overall, Mortality rates for adult recipients were 6.4% at 6 months and 7.9% at 1 year for transplants in 2018, 14.4% at 3 years for transplants in 2016, and 20.1% at 5 years for transplants in 2014. Mortality rates for pediatric recipients were 6.3% at 6 months and 8.2% at 1 year for transplants in 2018, 10.3% at 3 years for transplants in 2016, and 17.8% at 5 years for transplants in 2014.

Pig-to-human heart transplantation: Who goes first?

“…A growing number of heart transplant recipients develop chronic allograft dysfunction, usually in association with cardiac allograft vasculopathy (CAV). 2 Although some patients with CAV currently benefit from timely cardiac retransplantation, only a minority are considered acceptable candidates due to comorbidities associated with nephrotoxic drugs and other complications of chronic immunosuppression and progressive cardiovascular disease. Many listed retransplant candidates are sensitized to alloantigens expressed by their heart allograft, or as a consequence of blood product transfusion or other tissue allograft exposure.…”

“…Retransplantation is associated with lower graft survival, particularly in patients with acute graft failure. 2,25 Furthermore, in contrast to a xenograft, allocating an allograft to a prior recipient reduces the number of organs available for primary transplant candidates.…”

“…Sharing urgency for heart transplantation, and experience a high mortality rate on the waiting list. 2,31,32 Xenotransplantation could be considered for adult congenital heart disease patients who are not candidates for VAD support and for whom access to an allograft is improbable due to sensitization (high PRA) or for other reasons.…”

Impact of diabetes and chronic dialysis on post‐transplant survival in combined heart‐kidney transplant recipients

“…According to the most recent Scientific Registry of Transplant Recipients (SRTR) data, the number of heart-kidney transplants increased from 53 (2.8%) to 184 (6.5%) between 2007 and 2017. 11 Despite the survival benefit of combined heart-kidney transplantation in heart transplant recipients with renal failure, kidney transplantation cannot completely negate the ill effects of renal failure, particularly in diabetic recipients who have been on long-term dialysis. The decision to pursue combined heart-kidney transplant in chronic dialysis patients awaiting heart transplant may seem straightforward but this population suffers from multiple medical co-morbidities that are not always clearly delineated during the transplant evaluation.…”

Learning networks in pediatric heart failure and transplantation

“…In the United States, approximately 500 HTs are performed annually in patients <18 years of age, a number that have plateaued in recent years. 2 Early outcomes after HT in children are quite favorable, with 90%-95% 1-year survival; furthermore, the majority of recipients report minimal limitations in activities of…”