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Impact of Center Donor Acceptance Patterns on Utilization of Extended-Criteria Donors and Outcomes
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  • Nicholas Hess,
  • Laura Seese,
  • Ibrahim Sultan,
  • Yisi Wang,
  • Floyd Thoma,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center
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Laura Seese
University of Pittsburgh Medical Center Health System
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Ibrahim Sultan
University of Pittsburgh
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Yisi Wang
University of Pittsburgh Medical Center Health System
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Floyd Thoma
University of Pittsburgh Medical Center Health System
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Arman Kilic
University of Pittsburgh Medical Center Health System
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Abstract

Background: This study investigated the impact of transplanting center donor acceptance patterns on usage of extended-criteria donors (ECDs) and posttransplant outcomes following orthotopic heart transplantation (OHT). Methods: The Scientific Registry of Transplant Recipients was queried to identify heart donor offers and adult, isolated OHT recipients in the United States from 1/1/2013-10/17/2018. Centers were stratified into 3 equal-size terciles based on donor heart acceptance rates (<13.7%, 13.7%-20.2%, >20.2%). Overall survival was compared between recipients of ECDs (≥40 years, left ventricular ejection fraction <60%, distance ≥500 miles, hepatitis B, hepatitis C or human immunodeficiency virus, or ≥50 offers) and recipients of traditional-criteria donors, and among transplanting terciles. Results: A total of 85,505 donor heart offers were made to 133 centers with 15,264 (17.9%) accepted for OHT. High-acceptance programs (>20.2%) more frequently accepted donors with LVEF <60%, HIV, HCV, and/or HBV, ≥50 offers, or distance >500 miles from the transplanting center (each p<0.001). Posttransplant survival was comparable across all three terciles (p=0.11). One- and five-year survival were also similar across terciles when examining recipients of all five ECD factors. Acceptance tier and increasing acceptance rate were not found to have any impact on mortality in multivariable modeling. Of ECD factors, only age ≥40 years was found to have increased hazards for mortality (HR 1.33, 95% CI 1.22-1.46, p<0.001). Conclusions: Of recipients of ECD hearts, outcomes are similar across center-acceptance terciles. Educating less aggressive programs to increase donor acceptance and ECD utilization may yield higher national rates of OHT without major impact on outcomes.

Peer review status:ACCEPTED

29 Dec 2020Submitted to Journal of Cardiac Surgery
30 Dec 2020Submission Checks Completed
30 Dec 2020Assigned to Editor
08 Mar 2021Review(s) Completed, Editorial Evaluation Pending
12 Apr 2021Reviewer(s) Assigned
20 Apr 2021Editorial Decision: Revise Minor
18 May 20211st Revision Received
19 May 2021Assigned to Editor
19 May 2021Submission Checks Completed
19 May 2021Reviewer(s) Assigned
04 Jun 2021Review(s) Completed, Editorial Evaluation Pending
04 Jun 2021Editorial Decision: Revise Minor
07 Jun 20212nd Revision Received
08 Jun 2021Submission Checks Completed
08 Jun 2021Assigned to Editor
10 Jun 2021Reviewer(s) Assigned
02 Jul 2021Review(s) Completed, Editorial Evaluation Pending
02 Jul 2021Editorial Decision: Accept