The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report—2018; Focus Theme: Multiorgan Transplantation

Khush, Kiran K.; Cherikh, Wida S.; Chambers, Daniel C.; Goldfarb, Samuel; Hayes, Don; Kucheryavaya, Anna Y.; Levvey, Bronwyn; Meiser, Bruno; Rossano, Joseph W.; Stehlik, Josef

doi:10.1016/j.healun.2018.07.022

Cited by 457 publications

(432 citation statements)

References 14 publications

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“…First, clinical worsening of patients on the waiting list leads to an increase in the number of emergent HTs, which already accounts for almost 50% of the HTs performed in Spain 6 ; performing emergency HTs may increase costs and worsen the short-term outcome of the HT. 5 Third, there is a need for the use of alternative strategies, such as technology: Long-term VADs have shown a clear increase in survival in the recent years, leading to 2-year outcomes comparable to HT. 5 Third, there is a need for the use of alternative strategies, such as technology: Long-term VADs have shown a clear increase in survival in the recent years, leading to 2-year outcomes comparable to HT.…”

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confidence: 99%

“…5 Third, there is a need for the use of alternative strategies, such as technology: Long-term VADs have shown a clear increase in survival in the recent years, leading to 2-year outcomes comparable to HT. 5 VAD implantation is economically limited in some countries due to their high acquisition costs. 5 VAD implantation is economically limited in some countries due to their high acquisition costs.…”

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confidence: 99%

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Elective or emergency heart transplantation: Cost comparison in a single center

Farrero

Flores‐Umanzor

Pomar

et al. 2019

Clinical Transplantation

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Background and aims Heart transplantation (HT) is the treatment of choice for selected cases of advanced heart failure. There is an increasing rate of emergency HT in our country. The aim of this study was to determine the cost of HT in our hospital according to emergent vs. elective transplantation status. Methods The costs of all consecutive HTs performed in our center between January 2010 and May 2015 were analyzed. The cost of elective and emergent HT was compared. Results HT mean cost at our institution was €62 203 ± 47 976. Elective HT mean cost was €47 540 ± 25 140, whereas emergent HT cost was €102 733 ± 68 050 (emergency status 1, as regional priority, was €66 077 ± 28 067 and emergency status 0, as the highest national priority, was €136 056 ± 77 080; P < 0.001). Increased emergent HT cost was mainly related to a longer admission (32 ± 24 days vs. 69 ± 53 days; P = 0.006; accounting for a cost of €14 517 ± 12 475 vs. €37 846 ± 31 702; P < 0.001) and increased drug‐related expenses (€6622 ± 7465 vs. €15,171 ± 15,758; P < 0.02). Elective HT survival rate was 96%, compared to 68% for emergent HT; P = 0.002. Conclusions Elective HT showed a high survival rate with a relatively low and less variable cost, leading to a favorable economic balance in today's public health reimbursement system. In contrast, emergent HT showed a higher cost and a lower survival rate. New treatment strategies should be identified for heart failure patients at risk of requiring emergency HT.

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confidence: 99%

mentioning

confidence: 99%

Elective or emergency heart transplantation: Cost comparison in a single center

Farrero

Flores‐Umanzor

Pomar

et al. 2019

Clinical Transplantation

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“…The number of HTs reported to the international registry, which is estimated to be 80% of those performed worldwide, has increased steadily over the last decade but the increase remains in the order of <5% per year,1 reflecting both slowly increasing donor numbers and with more intense logistics and management, greater acceptance of donors offered. This falls well short of the need for growth in the CHD population suggested by Dimopoulos et al 4.…”

Section: Barriers To Transplantation In Patients With Chdmentioning

confidence: 99%

“…Heart transplantation (HT) is an established treatment for patients with end-stage heart disease in whom all other management options have been exhausted, providing excellent functional capability and a good median-term survival, now exceeding 12 years 1. The two most common causes of heart failure in those undergoing HT are dilated cardiomyopathy (50.5%) and ischaemic heart disease (33.1%) 1.…”

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confidence: 99%

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Transplantation: the final hurdle to longevity in patients with congenital heart disease

Ruygrok

2019

Heart

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Expanding Heart Transplant in the Era of Direct-Acting Antiviral Therapy for Hepatitis C

et al. 2020

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IMPORTANCE For patients awaiting heart transplant, hepatitis C-positive donors offer an opportunity to expand the donor pool, shorten wait times, and decrease wait-list mortality. While early reported outcomes among few heart transplant recipients have been promising, knowledge of 1-year outcomes in larger cohorts of patients is critical to shared decision-making with patients about this option.OBJECTIVE To better define the association of hepatitis C-positive donors with heart transplant volumes, wait-list duration, the transmission and cure of donor-derived hepatitis C, and morbidity and mortality at 1 year. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, single-center observational study of 80 adult (age 18 years or older) patients who underwent heart transplant using hearts from hepatitis C-positive donors between September 2016 and April 2019 at a large academic medical center. Among donors, who were considered hepatitis C-positive if results from hepatitis C antibody and/or nucleic acid testing were positive, 70 had viremia and 10 were seropositive but did not have viremia. Follow-up was available through May 15, 2019. Comparisons were drawn with patients who underwent transplant with hearts from hepatitis C-negative donors during the same period.EXPOSURES In addition to standard posttransplant management, transplant recipients who developed donor-derived hepatitis C infection were treated with direct-acting antivirals. MAIN OUTCOMES AND MEASURESThe main outcomes included wait-list duration and 1-year survival in all patients, and for those who developed donor-derived hepatitis C, the response to direct-acting antiviral treatment. RESULTSOf 80 patients, 57 (71.3%) were men, 55 (68.7%) were white, and 17 (26.3%) were black; the median age at transplant was 54.5 years (interquartile range, 46-62 years). Following consent to accept hearts from hepatitis C-exposed donors, the median days to heart transplant was 4 (interquartile range, 1-18). No recipients of donors with negative nucleic acid testing results (10 [12.5%]) developed donor-derived hepatitis C. Of 70 patients who were recipients of donors with positive nucleic acid testing results, 67 (95.7%) developed donor-derived hepatitis C over a median follow-up of 301 days (interquartile range, 142-617). Treatment with direct-acting antivirals was well tolerated and yielded sustained virologic responses in all treated patients. Within the cohort with infection, 1-year patient survival was 90.4%, which was not significantly different compared with the cohort without infection or with patients who received transplants from hepatitis C-negative donors during the same period. CONCLUSIONS AND RELEVANCEIn the era of direct-acting antivirals, hepatitis C-positive donors are a viable option to expand the donor pool, potentially reducing wait-list duration and mortality. In heart transplant recipients with donor-derived hepatitis C, infection is well-tolerated and curable, and 1-year survival is equivalent to that in recipients of hepatitis C-negative donors.

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The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report—2018; Focus Theme: Multiorgan Transplantation

Cited by 457 publications

References 14 publications

Elective or emergency heart transplantation: Cost comparison in a single center

Elective or emergency heart transplantation: Cost comparison in a single center

Transplantation: the final hurdle to longevity in patients with congenital heart disease

Expanding Heart Transplant in the Era of Direct-Acting Antiviral Therapy for Hepatitis C

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