Background: The purpose of the present study was to characterize the impact of the 2018 adult heart allocation policy change on waiting list and posttransplant outcomes of heart retransplantation in the United States.
Methods: All adults listed for heart retransplantation from May 2015 to June 2022 were identified using the United Network for Organ Sharing database. Patients were stratified into eras (era 1 and era 2) based on the heart allocation change on October 18, 2018. Competing risks regressions and Cox proportional hazards models were used to assess differences across eras in waiting list outcomes and 1-year posttransplant survival, respectively.
Results: The analysis included 356 repeat heart transplant recipients, with 207 (58%) receiving retransplantation during era 2. Patients who received a retransplant in era 2 were more commonly bridged with extracorporeal membrane oxygenation (21% vs 8%, P < .01) and intra-aortic balloon pump (29% vs 13%, P < .001) and had a lower likelihood of death/deterioration on the waiting list (subdistribution hazard ratio, 0.52; 95% CI, 0.33-0.82) compared with those in era 1. Rates of 30-day mortality (7% vs 7%, P = .99) and 1-year survival (82% vs 87%, P = .27) were not significantly different among retransplantation recipients across eras. After adjustment, retransplantation in era 2 was not associated with an increased hazard of mortality (adjusted hazard ratio, 1.13; 95% CI, 0.55-2.30). The gap in 1-year mortality between primary transplant and retransplant recipients increased from era 1 to 2.
Conclusions: Heart retransplantation candidates have experienced improved waiting list outcomes after the 2018 adult heart allocation policy, without significant changes to posttransplant survival.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.athoracsur.2023.09.001 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Thirty years of lung transplantation: development of postoperative outcome and survival over three decades.
J Thorac Dis
December 2024
Division of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany.
Background: Lung transplantation (LuTX) can be the last resort for patients with end-stage lung diseases. In the last decades, improvements were implemented in transplant medicine, from immunosuppression throughout preservation of the donor organ to enhance lung allograft survival. This retrospective study aims to illustrate the development of the LuTX-program at the University Hospital of Munich, LMU, Munich, Germany, since its launch in 1990 by depicting and comparing postoperative outcome.
View Article and Find Full Text PDFPET/CT with Myocardial Blood Flow Assessment Is Prognostic of Cardiac Allograft Vasculopathy Progression and Clinical Outcomes.
J Nucl Med
January 2025
Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York;
Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial vessels and microvasculature and remains a leading cause of posttransplant morbidity and mortality. This study examined the prognostic value and outcomes of CAV, assessed by N-ammonia PET/CT myocardial perfusion imaging in heart transplant recipients. PET/CT and invasive coronary angiography (ICA) were graded using validated scales.
View Article and Find Full Text PDFHeart Transplantation Outcomes for Fontan Patients When Using Contemporary Strategies: Heart-Liver Transplantation and Ventricular Assist Device Therapy.
World J Pediatr Congenit Heart Surg
January 2025
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Background: With an increasing number of Fontan patients surviving into adulthood, the burden of end-stage heart failure is increasing. Prior studies have reported suboptimal heart transplantation (HTx) outcomes. Therefore, the authors describe their institutional experience of HTx in patients with Fontan circulation failure, including heart-liver transplantation (HLTx) and pretransplant systemic ventricular assist device (SVAD) therapies.
View Article and Find Full Text PDFIn the Twilight of Evidence: Is Bypass Surgery Still on the Table for Cardiac Allograft Vasculopathy?
J Clin Med
December 2024
Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland.
Cardiac allograft vasculopathy (CAV) is a major prognosis-limiting factor in patients undergoing orthotopic heart transplantation (HT). Due to the diffuse involvement of the coronary tree, CAV lesions are often not amenable to percutaneous coronary intervention (PCI), leaving coronary artery bypass grafting (CABG) and retransplantation as primary revascularization options. : The latest guidelines from the International Society for Heart and Lung Transplantation (ISHLT) recognize CABG as a viable option but with a downgraded strength of recommendation.
View Article and Find Full Text PDFFate of Semilunar Valves From Discarded Hearts at the Time of Pediatric Heart Retransplantation.
Pediatr Transplant
February 2025
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Background: Partial heart transplantation (PHT) is a novel procedure for children in need of a growing valve replacement option. One challenge is identifying suitable donor valves. Semilunar heart valves from patients receiving a retransplant may be a source, however their functionality and growth potential especially at the time of retransplant are unknown.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!