Non-inferior outcomes in lower urgency patients transplanted with extended criteria donor hearts

Area of Science:

• Cardiology
• Transplantation Medicine
• Organ Donation

Background:

• Recent research suggests donor comorbidities may not significantly affect outcomes for lower-urgency heart transplant patients (UNOS Status 4 or 6).
• Extended criteria donors (ECD) are defined as donor hearts not meeting established acceptable use criteria.

Purpose of the Study:

• To investigate the outcomes of using extended criteria donor (ECD) hearts in lower-urgency versus higher-urgency heart transplant recipients.
• To determine if ECD hearts impact survival rates in different urgency groups.

Main Methods:

• Utilized the United Network for Organ Sharing (UNOS) database for adult heart transplantations between October 2018 and December 2021.
• Stratified patients into higher urgency (UNOS 1 or 2) and lower urgency (UNOS 4 or 6) groups.
• Compared outcomes using propensity score matched cohorts for recipients of ECD versus standard donor hearts.

Main Results:

• Among 9,160 patients, 25.4% were low urgency. ECD hearts were used in 35.5% of higher-urgency and 39.2% of lower-urgency patients.
• ECD hearts significantly impacted survival in high-urgency patients (p < 0.01).
• No significant difference in 1- and 2-year survival was observed for low-urgency patients receiving ECD versus standard hearts (p > 0.05). ECDs were not independently associated with mortality in this group.

Conclusions:

• Post-transplant outcomes for low-urgency heart transplant recipients are not adversely affected by using ECD versus standard donor hearts.
• Optimizing the use of ECDs in lower-urgency patients could potentially increase transplant frequency and decrease waitlist morbidity.
• Expanding the donor pool through judicious ECD use may improve overall outcomes for the heart transplant community.