Patient Selection and Indications for Liver Transplantation

Brown, Kimberly; Kazimi, Marwan

doi:10.1002/9781118873434.ch29

Cited by 2 publications

(4 citation statements)

References 135 publications

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Section: Introductionmentioning

confidence: 99%

“…1 Of those with heart failure, over 10% have end-stage disease. 1,2 Even though the total number of available donor hearts has steadily increased since 2011, the acceptance rate of donor hearts has decreased to 30% in 2018 from its peak of 45% in 1995. 3 The risk profile of donor-recipient sex-mismatching has been a focal point of recent research including all-cause mortality, stroke, dialysis, and graft dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Sex-Mismatching in Isolated Heart Transplant Confers No Postoperative Risk

Dale,

Leipzig,

Bahatyrevich

et al. 2024

Preprint

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Background: For heart transplantation, optimal donor-recipient matching is an important factor in the ongoing development of the United Network for Organ Sharing (UNOS) continuous distribution framework. Donor-recipient sex-mismatch has decreased since the 1990s, but this may be related to the risk posed by size mismatching, particularly when donor hearts are undersized. Thus, the impact of sex-mismatching, controlling for other factors including size mismatch, is uncertain. Methods: Adult first-time, isolated heart transplant patients from the UNOS database between October 1, 1987 and December 31, 2022 were analyzed. Cohorts were separated into male and female recipients. Propensity score matching on known preoperative risk factors was performed. Equivalence testing via Two One-Sided Testing (TOST) was performed to assess between-arm equivalence in postoperative outcomes. Survival differences were measured by the between-arm ratio of Restricted Mean Survival Time and binary outcome differences by the Odds Ratio (OR). Results: In the propensity matched cohort, we found significant equivalence between arms in both male (TOST P<0.001) and female (TOST P<0.001) recipients for overall survival at all temporal endpoints, postoperative treatment for rejection within one year, and pre-discharge dialysis. Conclusions: Sex-mismatch in isolated heart transplantation confers no additional risk to postoperative outcomes when controlling for other factors, including size mismatch. Consequently, sex-mismatch should not factor into individual assessments of organ acceptance or be incorporated into any national organ allocation policy. Increasing the acceptance of sex-mismatched donors has the potential to expand the donor pool and increase female donor utilization.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sex-Mismatching in Isolated Heart Transplant Confers No Postoperative Risk

Dale,

Leipzig,

Bahatyrevich

et al. 2024

Preprint

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“…Heart transplantation is the only definitive and effective treatment for patients with advanced refractory heart failure. However, given the limited availability of donor organs, heart transplant candidates undergo rigorous screening including evaluation for peripheral arterial disease (PAD) 1,2 . About 30% of candidates are turned down due to moderate‐to‐severe PAD, as its presence is a relative contraindication and associated with significant morbidity and early mortality posttransplant 1,2 .…”

Section: Introductionmentioning

confidence: 99%

“…However, given the limited availability of donor organs, heart transplant candidates undergo rigorous screening including evaluation for peripheral arterial disease (PAD) 1,2 . About 30% of candidates are turned down due to moderate‐to‐severe PAD, as its presence is a relative contraindication and associated with significant morbidity and early mortality posttransplant 1,2 . PAD is also believed to be associated with a higher risk of transplant vasculopathy and rejection 2 .…”

Section: Introductionmentioning

confidence: 99%

The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity‐matched analysis of the nationwide inpatient sample database

et al. 2021

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Left ventricular assist device (LVAD) candidacy screening includes evaluation for peripheral arterial disease (PAD). However, given current evidence, the impact of PAD on post-LVAD complications remains unknown. The National Inpatient Sample (NIS) database (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) was utilized to identify all LVAD cases. The in-hospital safety endpoints included major cardiovascular adverse events and its components. A propensity-matched analysis was used to obtain adjusted odds ratios (aOR). A subgroup analysis of patients with diabetes mellitus (DM) with PAD was also performed. A total of 27 424 patients with LVAD implantation (PAD: 516 [1.8%] and no-PAD 26 908 [98.2%]) were included. There were significant intergroup differences in the demographics and baseline comorbidities. A weighted sample of 1053 (no-PAD 537, PAD 516) propensity-matched population was selected.The adjusted odds for in-hospital mortality (aOR 1.7; 95% CI, 1.2-2.44, P = .004) were found to be significantly higher for LVAD-patients with PAD. There was no significant difference in the adjusted odds of MACE (aOR 1.16, 95% CI 0.87-1.5), postprocedure bleeding (aOR 0.88, 95% CI 0.62-1.26, P = .54) and risk of pneumonia (aOR 0.67, 95% CI 0.44-1.15, P = .63) between the two groups. A selected cohort of DM-only population (7339) consistently showed a higher adjusted mortality rate in PAD patients with LVAD implantation (aOR 2.3, 95% CI 1.2-4.47, P = .01). The rate of MACE (P = .17), myocardial infarction (P = .12), stroke (P = .60), postprocedural (0.10), and major bleeding (P = .51) remained identical between patients with PAD and those with no-PAD. PAD confers an increased risk of in-hospital all-cause mortality in patients undergoing LVAD implantation. This risk increases further in patients with a concomitant diagnosis of DM.

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Patient Selection and Indications for Liver Transplantation

Cited by 2 publications

References 135 publications

Sex-Mismatching in Isolated Heart Transplant Confers No Postoperative Risk

Sex-Mismatching in Isolated Heart Transplant Confers No Postoperative Risk

The impact of peripheral arterial disease on left ventricular assist device implantation: A propensity‐matched analysis of the nationwide inpatient sample database

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