Ten-Year Experience With Extended Criteria Cardiac Transplantation

Abstract

Background Extended criteria cardiac transplant (ECCT) programs expand the transplant pool by matching donors and recipients typically excluded from the transplant process because of age or co-morbidity. There is a paucity of data examining long-term outcomes with this strategy. Methods and Results Between January 2000 and December 2009, adult patients undergoing isolated heart transplant were prospectively classified as ECCT based on pre-specified criteria. Baseline characteristics and outcomes were compared between ECCT and standard criteria cardiac transplant (SCCT) recipients. Two Cox proportional hazards models were developed. The first to identify clinical variables contributing to survival between the two groups, and the second to determine the additional risk associated with assignment to ECCT. Among the 454 patients who underwent heart transplant, 84 (18.5%) were ECCT. Compared to SCCT, ECCT patients were older (median 66.6 yrs vs. 53.2 yrs, p<0.001), with higher frequency of diabetes (46.4% vs. 24.6%, p<0.001) and chronic kidney disease (median eGFR 55 ml/min vs. 61.6, ml/min, p=0.001). After adjustment for baseline characteristics, SCCT survival was higher than ECCT at 1 (89% vs. 86%; p=0.18) and 5 (77% vs. 66%; p=0.035) years. In a multivariate model that included listing criteria, Cr (HR = 1.05 per 0.1 mg/DL, 95% CI: (1.02, 1.09), P=0.001) was a significant predictor of post-transplant mortality. Conclusions ECCT is an acceptable alternative for advanced heart failure therapy in select patients. Age and renal dysfunction are important determinants of long-term survival and post-transplant morbidity.

Cardiac transplantation for older patients: Characteristics and outcomes in the septuagenarian population

“…3,17 The criteria used for determining an alternate (or extended criteria) donor varies by transplant center, but have shown to effectively maximize the use of donor organs that otherwise would remain unused and therefore extend the option of transplantation to recipients who otherwise may not have been offered this treatment option. 18-24 Alternate donor use is not captured in the UNOS database, but our results show that older recipients receive organs from donors with older age, more comorbidities, and other high risk features, such as substance abuse. Furthermore, donors from older recipients had longer ischemic times, suggesting that transplant programs may accept donor organs from a greater distance for these patients.…”

Heart transplantation from cardiac arrest-resuscitated donors

“…Однако сохраняющаяся высокой диспропорция между количеством подходящих для трансплантации донорских сердец и количеством пациентов, нуждающихся в ТС (прежде всего в ее неотложном выполнении), способствует либерализации критериев сердечного донорства [14]. Использование сердец от доноров, перенесших СЛР, является одним из подходов к расширению критериев сердечного донорства [13].…”

Cardiac Transplantation for Older Patients: Characteristics and Outcomes in the Septuagenarian Population

“…3,17 The criteria used for determining an alternate (or extended criteria) donor varies by transplant center, but have shown to effectively maximize the use of donor organs that otherwise would remain unused and therefore extend the option of transplantation to recipients who otherwise may not have been offered this treatment option. [18][19][20][21][22][23][24] Alternate donor use is not captured in the UNOS database, but our results show that older recipients receive organs from donors with older age, more comorbidities, and other high risk features, such as substance abuse. Furthermore, donors from older recipients had longer ischemic times, suggesting that transplant programs may accept donor organs from a greater distance for these patients.…”