Prolonged Ischemia Times for Heart Transplantation: Impact of the 2018 Allocation Change

Kwon, Jennie H.; Huckaby, Lauren V.; Sloan, Brandon; Pope, Nicolas H.; Witer, Lucas; Tedford, Ryan J.; Houston, Brian A.; Hashmi, Zubair A.; Katz, Marc; Kilic, Arman

doi:10.1016/j.athoracsur.2022.02.029

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…This results in lower quality organs which may lead to more complications and portend higher mortality after surgery. 12,13 Prolonged ischemic time has also been correlated to worse outcomes after transplantation: in a recent analysis of international registries prolonged ischemia time was related to increase 1-year mortality and longer LOS when greater than 4 h. 14,15 In our analysis, we have also found that a male donor heart is a protective factor in terms of length of stay, while in contrast, a female donor is associated with longer length of stay. Female donors portend worse outcomes than male particularly when gender mismatch is present (female donor-male recipient), but our group in a recent analysis showed sex mismatching is associated with worse post-transplant outcomes only when not adjusted for common risk factors.…”

Section: Discussionsupporting

confidence: 61%

“…This results in lower quality organs which may lead to more complications and portend higher mortality after surgery 12,13 . Prolonged ischemic time has also been correlated to worse outcomes after transplantation: in a recent analysis of international registries prolonged ischemia time was related to increase 1‐year mortality and longer LOS when greater than 4 h 14,15 …”

Section: Discussionmentioning

confidence: 99%

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

Doulamis,

Gemelli,

Rempakos

et al. 2023

Clinical Transplantation

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BackgroundUnited Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of ventricular assist device use as a bridge to heart transplant, which consequently prioritized sicker patients. We aimed to assess the impact of this new allocation policy on the length of stay following heart transplantation. Secondary outcomes include other risk factors for prolonged hospitalization and its effect on mortality and postoperative complications.MethodsThe UNOS Registry was queried to identify patients who underwent isolated heart transplants in the United States between 2001 and 2023. Patients were divided into quartiles according to their respective length of stay.ResultsA total of 57 020 patients were included, 15 357 of which were allocated with the new system. The median hospital length of stay was 15 days (mean 22.7 days). Length of stay was longer in the new allocation era (25 ± 30 vs. 22 ± 27 days, p < .001). The longer length of stay was associated with increased 5‐year mortality in the new allocation system (aHR: 1.18; 95% CI: 1.15, 1.20; p‐value: < .001).ConclusionLonger hospital stays and associated observed increased risk for mortality in the era after the allocation criteria change reflect the rationale of this shift which was to prioritize heart transplants for sicker patients. Further studies are needed to track the progress of surgical and perioperative management of these studies over time.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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

Doulamis,

Gemelli,

Rempakos

et al. 2023

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…First, in 2018 the United Network for Organ Sharing imposed changes on the allocation policy for heart donors with one of the major consequences of those changes being an increase in donor ischemia times and an accompanying decrease in 1-year posttransplant mortality. 10 This, however, was a predictable outcome for a policy change aimed at improving waitlist outcomes and which has largely achieved that goal. [11][12][13] In parallel to these policy changes, technologies have been in development to mitigate the impact of donor ischemia.…”

mentioning

confidence: 99%

“…The implications of these findings would entail a decreased tolerance for donor heart ischemia, particularly when ischemic times are expected to be beyond 3 h. However, a broader understanding of the current status of the field of heart transportation can demonstrate why the application of these findings may be limited. First, in 2018 the United Network for Organ Sharing imposed changes on the allocation policy for heart donors with one of the major consequences of those changes being an increase in donor ischemia times and an accompanying decrease in 1‐year posttransplant mortality 10 . This, however, was a predictable outcome for a policy change aimed at improving waitlist outcomes and which has largely achieved that goal 11–13 .…”

mentioning

confidence: 99%