Outcomes After Transplantation of Donor Hearts With Improving Left Ventricular Systolic Dysfunction

Madan, Shivank; Saeed, Omar; Vlismas, Peter; Katsa, Ioanna; Patel, Snehal R.; Shin, Julia; Jakobleff, William; Goldstein, Daniel J.; Sims, Daniel B.; Jorde, Ulrich P.

doi:10.1016/j.jacc.2017.07.728

Cited by 59 publications

(57 citation statements)

References 19 publications

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“…Similarly, rigorous studies focused on defining acceptable donor and recipient age and size combinations are required, as donor age, height, and BMI were variable across centers with respect to offer acceptance, organ acceptance, and organ sequence number. Finally, transplant centers continue to demonstrate variability in their willingness to accept donor hearts with LV dysfunction (ejection fraction [EF] ≤ 50%), despite several recent studies showing that recipients of carefully selected donors with LV dysfunction have excellent posttransplant outcomes …”

Section: Discussionmentioning

confidence: 99%

Great variability in donor heart acceptance practices across the United States

Khush

Ball

2020

American Journal of Transplantation

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Disparities in organ acceptance practices exacerbate donor heart nonuse and lead to increased waiting times and mortality for heart transplant candidates. We studied disparities in donor heart acceptance among US transplant centers and their relations to posttransplant outcomes. Candidate, potential transplant recipient match run, and deceased donor data were obtained from the United Network for Organ Sharing. We analyzed donor, candidate, and transplant center characteristics with respect to organ acceptance, offer acceptance, number of offers before acceptance (organ sequence number), and association with posttransplant mortality. A total of 693 420 donor heart offers made between April 2007 and December 2015 were included. We identified great variability in donor heart acceptance practices among US heart transplant centers. We identified donor and recipient characteristics that were strongly associated with heart organ and offer acceptance, and organ sequence number, and identified inconsistencies among centers with respect to how these characteristics influenced acceptance decisions. Finally, we identified characteristics that were highly predictive of donor heart nonuse and were not associated with increased recipient mortality, which may guide future efforts aimed at increasing use of available hearts for transplantation.

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Section: Discussionmentioning

confidence: 99%

Great variability in donor heart acceptance practices across the United States

Khush

Ball

2020

American Journal of Transplantation

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“…Furthermore, our parameters for the ideal donor heart are far more restrictive than current practice, especially with regard to normal ejection fraction, as there are data to support that lower ejection fraction hearts are acceptable organs, especially when procured from young donors. 25,26 In addition, our study was limited by the small volume of DCD donor information available for review. Finally, given the sensitivity of detailed donor information, one-time chart review of DCD donors in Region 9 that were not accessed for clinical reasons limited our ability to expand this study to other Regions in the United States.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our parameters for the ideal donor heart are far more restrictive than current practice, especially with regard to normal ejection fraction, as there are data to support that lower ejection fraction hearts are acceptable organs, especially when procured from young donors 25,26. If this number were to increase by even 2-fold, this would yield a significant increase in the heart donor pool, suggesting that our study likely underestimates the potential of DCD donation.…”

mentioning

confidence: 93%

Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset

Farr

Truby

Lindower³

et al. 2020

American Journal of Transplantation

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Donation after Circulatory Death (DCD) is an alternative to Donation after Brain death (DBD), and is a growing strategy for organ procurement in the United States(US). The purpose of this analysis was to review the number and quality of hearts in one United Network for Organ Sharing (UNOS) Region that were not utilized as a potential consequence of nonheart DCD donation. We retrospectively identified all successful US DCD solid organ donors from 1/2011 to 3/1/2017, defined an ideal heart donor by age and left ventricular ejection fraction (LVEF), and then reviewed the donor charts of unused hearts in New York and Vermont (UNOS Region 9). Of 8302 successful DCD donors across the United States, 5033 (61%) were between 18 and 49 years of age, and 872 had a screening echocardiogram, with 573 (66%) measuring an EF >50%.Of these 573 potential donors, 44 (7.7%) were from Region 9. Detailed donor chart review identified 36 ideal heart donors, 24 (66.7%) with anoxic brain injury. Trends in Region 9 DCD donation increased from 4 unused hearts in 2011, to 13 in 2016. In the context of severe organ scarcity, these data indicate that implementation of DCD heart transplantation in the United States would improve overall donation rates and provide a pathway to utilize these ideal donor hearts. K E Y W O R D Sclinical research/practice, donors and donation: donation after circulatory death (DCD), donors and donation: donor evaluation, donors and donation: extended criteria, ethics and public policy, heart transplantation/cardiology

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“…A recent analysis of data from the Spanish Heart Transplantation Registry was cautiously reassuring, demonstrating no survival disadvantage in recipients of donor hearts aged more than 50 years. However, after multivariate adjustment, recipients of these older hearts did have a higher incidence of cardiac allograft vasculopathy at 5 years after transplant [11]. Based on the International Society for Heart and Lung Transplantation (ISHLT) registry, the rate of death from graft failure early after transplantation is 3-4%.…”

Section: медицинский университет вены австрияmentioning

confidence: 99%

Rationale limits of organ donor maximization for heart transplantation

Цукерманн

Laufer

2019

RJTAO

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Cardiac transplantation is an established therapy for end-stage heart failure. The number of heart transplant procedures performed worldwide has remained relatively unchanged in recent years. Although mortality rates on the waiting list have improved due to improved ventricular assist devices and rhythm correction techniques, it remains imperative to maximize use of all potential donor hearts. The recipient now presents with multiple complexities. The continued divergence between the rising number of transplant candidates added to the transplant waiting list and the number of suitable organ donors has increased pressure on clinicians to maximize the use of available thoracic organs for transplantation.

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Outcomes After Transplantation of Donor Hearts With Improving Left Ventricular Systolic Dysfunction

Cited by 59 publications

References 19 publications

Great variability in donor heart acceptance practices across the United States

Great variability in donor heart acceptance practices across the United States

Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset

Rationale limits of organ donor maximization for heart transplantation

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