Heart Transplantation Utilizing Brain-Dead Donors Procured From Extended Distances Under the 2018 New Allocation Policy

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-02-27 DOI:10.1111/ctr.70122

Rintaro Kinjo, Sooyun Caroline Tavolacci, Shazli Khan, Kenji Okumura, Junichi Shimamura, David Spielvogel, Suguru Ohira

{"title":"Heart Transplantation Utilizing Brain-Dead Donors Procured From Extended Distances Under the 2018 New Allocation Policy","authors":"Rintaro Kinjo, Sooyun Caroline Tavolacci, Shazli Khan, Kenji Okumura, Junichi Shimamura, David Spielvogel, Suguru Ohira","doi":"10.1111/ctr.70122","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>There are limited data regarding outcomes of a new heart allocation policy on recovering brain-death donors (DBD) from extended distances.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>From May 6, 2014, to March 31, 2023, the United Network for Organ Sharing database was queried where 1885 cases (8.3%) out of 22 806 isolated heart transplants received donor hearts from extended distances (ED) greater than 500 miles. Patients were divided into groups based on the transplanted date before or after the policy change (October 18, 2018): old (<i>N</i> = 443) versus new (<i>N</i> = 1383). A total of 439 pairs were matched utilizing propensity score matching.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The utilization of hearts from ED in the new system increased 2.7 times. Before matching, characteristics that differed included new group recipients with higher usage of temporary mechanical circulatory support devices and donors with more anoxia as the cause of death (new, 47% vs. old, 37%; <i>p</i> < 0.001). In the matched cohort, the incidences of dialysis (14% vs. 11%, <i>p</i> = 0.18), stroke (3.9% vs. 2.7%, <i>p</i> = 0.44), or pacemaker implantation (3.0% vs. 2.5%, <i>p</i> = 0.83) were similar. Both groups showed similar 1-year recipient survival (90.9% vs. 90.4%, <i>p</i> = 0.79) and graft survival (90.7% vs. 90.2%, <i>p</i> = 0.8).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>In the new allocation policy, the utilization of hearts from ED has increased approximately three-fold compared to the period before the policy change without affecting transplant outcomes.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70122","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

There are limited data regarding outcomes of a new heart allocation policy on recovering brain-death donors (DBD) from extended distances.

Methods

From May 6, 2014, to March 31, 2023, the United Network for Organ Sharing database was queried where 1885 cases (8.3%) out of 22 806 isolated heart transplants received donor hearts from extended distances (ED) greater than 500 miles. Patients were divided into groups based on the transplanted date before or after the policy change (October 18, 2018): old (N = 443) versus new (N = 1383). A total of 439 pairs were matched utilizing propensity score matching.

Results

The utilization of hearts from ED in the new system increased 2.7 times. Before matching, characteristics that differed included new group recipients with higher usage of temporary mechanical circulatory support devices and donors with more anoxia as the cause of death (new, 47% vs. old, 37%; p < 0.001). In the matched cohort, the incidences of dialysis (14% vs. 11%, p = 0.18), stroke (3.9% vs. 2.7%, p = 0.44), or pacemaker implantation (3.0% vs. 2.5%, p = 0.83) were similar. Both groups showed similar 1-year recipient survival (90.9% vs. 90.4%, p = 0.79) and graft survival (90.7% vs. 90.2%, p = 0.8).

Conclusion

In the new allocation policy, the utilization of hearts from ED has increased approximately three-fold compared to the period before the policy change without affecting transplant outcomes.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

求助全文

约1分钟内获得全文去求助

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.