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Assessment of Heart Transplant Waitlist Time and Pre- and Post-transplant Failure: A Mixed Methods Approach
Benjamin A Goldstein1, Laine Thomas, Jonathan G Zaroff
1From the aDepartment of Biostatistics and Bioinformatics, Duke University, Durham, NC; bKaiser Northern California Division of Research, Oakland, CA; cDonor Network West, Oakland, CA; dGraduate School of Nursing, Midwifery, and Health, Victoria University of Wellington, Wellington, New Zealand; and eDivision of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
Insights
Longer wait times for heart transplantation increase the risk of transplant failure. Patients face the highest failure risk within the first 60 days on the waiting list.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Services Research
Background:
- Increasing wait times for heart transplantation over the past two decades.
- Concern regarding the impact of conservative donor heart acceptance on transplant failure rates.
Purpose of the Study:
- To investigate the association between heart transplant waiting time and transplant failure.
- To assess the risk conferred by donor heart acceptance practices.
Main Methods:
- Analysis of a cohort of 28,283 adult heart transplant candidates (2000-2010).
- Utilized Kaplan-Meier methods with inverse probability censoring weights.
- Employed blood type as an instrumental variable to assess wait time impact.
Main Results:
- Extended waiting times correlate with increased odds of transplant failure.
- The highest risk of failure occurs within the initial 60 days on the waiting list.
- Doubling wait time increased 1-year post-transplant failure odds by 10%.
Conclusions:
- A significant relationship exists between waiting time and heart transplant failure.
- Findings support refining donor heart quality and acceptance standards.
- Optimizing waitlist management is crucial for improving transplant outcomes.
Background:
Over the past two decades, there have been increasingly long waiting times for heart transplantation. We studied the relationship between heart transplant waiting time and transplant failure (removal from the waitlist, pretransplant death, or death or graft failure within 1 year) to determine the risk that conservative donor heart acceptance practices confer in terms of increasing the risk of failure among patients awaiting transplantation.
Methods:
We studied a cohort of 28,283 adults registered on the United Network for Organ Sharing heart transplant waiting list between 2000 and 2010. We used Kaplan-Meier methods with inverse probability censoring weights to examine the risk of transplant failure accumulated over time spent on the waiting list (pretransplant). In addition, we used transplant candidate blood type as an instrumental variable to assess the risk of transplant failure associated with increased wait time.
Results:
Our results show that those who wait longer for a transplant have greater odds of transplant failure. While on the waitlist, the greatest risk of failure is during the first 60 days. Doubling the amount of time on the waiting list was associated with a 10% (1.01, 1.20) increase in the odds of failure within 1 year after transplantation.
Conclusions:
Our findings suggest a relationship between time spent on the waiting list and transplant failure, thereby supporting research aimed at defining adequate donor heart quality and acceptance standards for heart transplantation.
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