Association of donor hypertension and outcomes in orthotopic heart transplantation

Outcomes of COVID-19-Positive Donor Heart Transplantation in the United States

Background Little is known regarding the impact of donor COVID-19 status on recipient outcomes after heart transplantation. In this study, we characterize outcomes of the first 110 heart transplants from organ donors positive for COVID-19 (COVID-19+) in the United States. Methods and Results Retrospective analysis of the United Network for Organ Sharing database was performed for single-organ adult heart transplants from January 2020 to March 2022. Donor COVID-19+ status was defined as a positive nucleic acid amplification, antigen, or other COVID-19 test within 7 days of transplant. Nearest-neighbor propensity score matching used to adjust for differences between recipients of COVID-19+ and nonpositive donor hearts. Overall, 7251 heart transplants were included in analysis, with 110 using COVID-19+ donor hearts. Recipients of COVID-19+ allografts were younger (54 [interquartile range, 41-61]) versus 57 [46-64] years; P=0.02) but had similar rates of female sex and non-White race compared with those receiving allografts from negative donors. Nearest-neighbor propensity score matching resulted in 100 well-matched pairs of recipients of COVID-19+ versus nonpositive donor organs. The 2 matched groups had similar median lengths of stay (15 [11-23] days versus 15 [13-23] days; P=0.40), rates of graft failure (1% versus 0%; P=0.99), 30-day death (3% versus 3%; P=0.99), and 3-month survival (88% versus 94%; P=0.23) compared with recipients of nonpositive donors. No deaths occurred due to COVID-19 infection among the 8 (7%) total deceased recipients of COVID-19+ allografts to date. Conclusions Short-term outcomes of heart transplant recipients receiving COVID-19+ donor organs are reassuring. However, continued monitoring for long-term survival and potential complications are warranted.

The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2021 Part II: Cardiac Transplantation

This article spotlights the research highlights of this year that specifically pertain to the specialty of anesthesia for heart transplantation. This includes the research on recent developments in the selection and optimization of donors and recipients, including the use of donation after cardiorespiratory death and extended criteria donors, the use of mechanical circulatory support and nonmechanical circulatory support as bridges to transplantation, the effect of COVID-19 on heart transplantation candidates and recipients, and new advances in the perioperative management of these patients, including the use of echocardiography and postoperative outcomes, focusing on renal and cerebral outcomes.

Center-Level Variation in Transplant Rates Following the Heart Allocation Policy Change

IMPORTANCE

Wide state-level variability in waiting list outcomes have been noted for patients listed for heart transplant in the US, but little is known regarding center-level transplant rates since the heart allocation policy change.

OBJECTIVE

To evaluate center-level transplant rates following the recent allocation policy change for heart transplant.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the United Network for Organ Sharing database from October 18, 2015, to March 1, 2020, for a nationwide analysis of transplant centers in the US. Transplant candidates were stratified into 2 time cohorts, with era 1 denoting the 3-year period before the policy change (October 18, 2018), and era 2 representing the 500-day period after the policy change but before the beginning of the COVID-19 pandemic. Data were analyzed from May to June 2021.

EXPOSURE

The heart allocation policy change enacted on October 18, 2018.

MAIN OUTCOMES AND MEASURES

Competing risk regression for waiting list outcomes was performed to calculate adjusted era 1 and era 2 center-level transplant rates. Rates were compared across regions and states, as well as within organ procurement organizations. Pearson correlation coefficient was used to assess center-level factors associated with era 2 transplant rates.

RESULTS

Of 15 940 transplant candidates included for analysis, 5063 (median [IQR] age, 56 [45-63] years; 1385 women [27.4%]) comprised the era 2 cohort. The proportion of patients with temporary mechanical circulatory support increased between era 1 and era 2 (extracorporeal membrane oxygenation, 2.00% vs 3.42%; percutaneous ventricular assist device, 0.66% vs 1.86%; intra-aortic balloon pump, 5.21% vs 13.10%). The adjusted mean center-level likelihood of transplant increased after the rule change (from 48.1% in era 1 to 78.0% in era 2). Significant variation in transplant rates was observed across regions and states even among centers with shared organ procurement organizations. The largest absolute difference in transplant rates was 27.1% for 2 centers belonging to the same organ procurement organization. Centers with higher transplant volumes in era 2 and with a greater proportion of candidates with intra-aortic balloon pump were observed to have higher transplant rates.

CONCLUSIONS AND RELEVANCE

Despite sharing organ supply and having a small geographical distance, these findings suggest that intercenter disparities in the likelihood of transplant have persisted following the heart allocation policy change. Further work is necessary to ensure equitable allocation of organs in heart transplant.