One-Year Outcomes Following Heart Transplantation Under the New Donor Heart Allocation System in the United States

HomeCirculation: Heart FailureVol. 14, No. 2One-Year Outcomes Following Transplantation Under the New Donor Allocation System in United States Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBOne-Year Taylor Nordan, BS, Andre C. Critsinelis, MD, Frederick Y. Chen, PhD, Navin K. Kapur, Katherine L. Thayer, MPH, Gregory S. Couper, MD and Masashi Kawabori, NordanTaylor Nordan https://orcid.org/0000-0002-1581-8214 Division of Cardiac Surgery (T.N., F.Y.C., G.S.C., M.K.), Tufts Medical Center, Boston, MA. Search for more papers by this author , CritsinelisAndre Critsinelis Department Surgery, Mount Sinai Miami, FL (A.C.C.). ChenFrederick Chen KapurNavin Kapur https://orcid.org/0000-0002-8302-6796 Cardiology (N.K.K., K.L.T.), ThayerKatherine Thayer https://orcid.org/0000-0002-0848-5853 CouperGregory Couper KawaboriMasashi Kawabori Correspondence to: 800 Washington St, MA, 02111. Email E-mail Address: [email protected] https://orcid.org/0000-0002-3580-5664 Originally published28 Jan 2021https://doi.org/10.1161/CIRCHEARTFAILURE.120.007754Circulation: Failure. 2021;14:e007754Other version(s) articleYou are viewing most recent version article. Previous versions: January 28, 2021: Ahead Print Survival following heart transplantation under new donor allocation system implemented on October 18, 2018, has been scrupulous investigation. Early reports 180-day freedom from death or retransplantation have produced mixed results. Cogswell et al1 initially reported 77.9% (hazard ratio [HR], 2.1 [95% CI, 1.5–3.0], P<0.001) compared with 93.4% old system.1 However, Hanff al2 Jawitz al3 recently comparable survival system.2,3 Although these early provide valuable information surrounding system, longer-term remains unknown. We report 1-year patients listed transplanted system. In addition, we free recipients bridged temporary mechanical circulatory support (MCS) waitlist outcomes candidates MCS.Since data Network Organ Sharing database publicly available deidentified, study was deemed exempt Institutional Review Board review. Requests access set qualified researchers trained human subject confidentiality protocols may be sent Sharing. Patients ≥18 years at time listing who received a first-time single-organ transplant were considered inclusion. 2015, through 17, those May 12, 2019.1–3 The used analysis contains follow-up current June 2020. before underwent after excluded analysis. Methodology identifying MCS previously described al.1 primary end point defined as retransplantation. secondary included removal due worsening clinical condition. Stata 16 (Stata Corp, College Station, TX) all statistical analyses. Univariate association between post-transplant assessed using Kaplan-Meier method. Multivariable Cox proportional hazards quantify change event-free adjustment key covariates. Covariates determined priori based prior literature1–3 included: recipient age, sex, cardiac surgery, failure cause, ischemic time, days waitlist, presence durable left ventricular assist device, sex mismatch, female male recipient. Restricted cubic splines 3 prespecified knots, distribution each variable, model linearity continuous variables hazard outcome. Propensity-score matching sensitivity analysis, 1:1 variables,3 performed. Fine-Gray competing risks performed analyze deterioration among MCS.Of 836 median 362 days. bridging changed follows, displayed absolute percentage differences: venoarterial extracorporeal membrane oxygenation: +5.1% (P<0.001), intraaortic balloon pump: +27.1% device: +4.9% (P<0.001) −21.3% (P<0.001). demonstrates similar (HR, 1.03 0.80–1.33], log-rank P=0.807; Figure [A]). models also demonstrate no significant difference morbidity mortality (adjusted HR, 1.04 0.79–1.36], P=0.789). identified 725 unique pairs demonstrated (log-rank P=0.182; [B]). 0.95 0.64–1.43], P=0.806; [C]). Adjustment covariates did not yield any 0.89 0.57–1.39], P=0.608). did, however, protection 0.53 0.36–0.76], P=0.001; [D]).Download figureDownload PowerPointFigure. comparison vs systems.A, Freedom 1 year systems. B, systems propensity-score matched cohorts. C, (MCS). D, Waitlist condition MCS. Adjusted estimates A C.Before many centers worried that increased use would lead increases postoperative mortality. This fear validated analyses systems, which excessive nonsurgical MCS.4,5 present indicate Further, significantly less likely experience Our results represent transplants occurred over 7 months cohort incompletely documented although 2020, used, bias informative censoring is unlikely.Nonstandard Abbreviations AcronymsHRhazard ratioMCSmechanical supportAcknowledgmentsThe here supplied contractor Procurement Network. interpretation reporting responsibility author(s) way should seen an official policy OPTN US Government.Sources FundingNone.Disclosures None.FootnotesThis manuscript Edo Birati, Guest Editor, review expert referees, editorial decision, final disposition.For Sources Funding Disclosures, see page 257.Correspondence kawabori.[email protected]comReferences1. R, John Estep JD, Duval S, Tedford RJ, Pagani FD, Martin CM, Mehra MR. An investigation 2018 States.J Lung Transplant. 2020; 39:1–4. doi: 10.1016/j.healun.2019.11.002CrossrefMedlineGoogle Scholar2. TC, Harhay MO, Kimmel SE, Birati EY, Acker Update 39:725–726. 10.1016/j.healun.2020.02.018CrossrefMedlineGoogle Scholar3. OK, Fudim M, Raman V, Bryner DeVore AD, Mentz Milano Patel CB, Schroder JN, Rogers JG. Reassessing system: updated UNOS registry analysis.JACC Fail. 8:548–556. 10.1016/j.jchf.2020.03.010CrossrefMedlineGoogle Scholar4. Yin MY, Wever-Pinzon O, MR, Selzman CH, Toll AE, Cherikh WS, Nativi-Nicolau J, Fang JC, Kfoury AG, Gilbert EM, al.. Post-transplant outcome devices.J 2019; 38:858–869. 10.1016/j.healun.2019.04.003CrossrefMedlineGoogle Scholar5. Castleberry AW, Southerland KW, JG, CA. Mortality differences pumps vs. 2013; 32:S23–S24. 10.1016/j.healun.2013.01.041CrossrefMedlineGoogle Scholar Back top Next FiguresReferencesRelatedDetailsCited By T, A, Ortoleva Kiernan Vest DeNofrio F, G M (2022) Durable Left Ventricular Assist Device Bridge System, ASAIO Journal, 10.1097/MAT.0000000000001599, 68:7, (890-898), Online publication date: 1-Jul-2022. Pahuja Hernandez-Montfort Whitehead E, N (2021) profile Impella 5.0 5.5 cardiogenic shock: overview its safety efficacy, Expert Devices, 10.1080/17434440.2022.2015323, 19:1, (1-10), 2-Jan-2022. Jani Lee Acharya Hoeksema Boeve Leacche Manandhar‐Shrestha N, Jovinge S Loyaga‐Rendon R Decreased frequency lower post‐transplant re‐transplantation LVAD Clinical Transplantation, 10.1111/ctr.14493, 36:1, 1-Jan-2022. Mantha Wolfson Patient selection transplant: balancing risk, Current Opinion 10.1097/MOT.0000000000000943, 27:1, (36-44), 1-Feb-2022. Abraham BLUMER BURKHOFF PAHUJA SINHA ROSNER VOROVICH GRAFTON G, BAGNOLA HERNANDEZ-MONTFORT J KAPUR Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation Management Considerations, Journal Failure, 10.1016/j.cardfail.2021.08.010, 27:10, (1126-1140), 1-Oct-2021. February 2021Vol Issue 2Article InformationMetrics © 2020 American Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.120.007754PMID: 33504156 publishedJanuary 2021 Keywordsheart transplantationheart failuresurvivalfreedomdeathPDF download Advertisement SubjectsCardiovascular SurgeryHeart FailureMortality/SurvivalTransplantation