Related Experiment Video
Updated: Jun 5, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Cardiac transplantation with increased-risk donors: Trends and clinical outcomes
Anusha Manjunath1, Jennifer Maning2, Tingquing Wu3
1Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America.
Insights
Orthotopic heart transplantation (OHT) using organs from Increased Risk Donors (IRD) shows similar long-term survival and graft failure rates compared to standard donors. IRD recipients experienced fewer hospitalizations for infection and rejection.
Area of Science:
- Cardiology
- Transplant Surgery
- Public Health
Background:
- Orthotopic heart transplantation (OHT) is a vital treatment for advanced heart failure.
- Hesitancy exists regarding organs from Increased Risk Donors (IRD) among recipients and clinicians.
- This study investigates trends in IRD acceptance and long-term outcomes in OHT.
Purpose of the Study:
- To analyze trends in the acceptance and utilization of Increased Risk Donor (IRD) organs in orthotopic heart transplantation (OHT).
- To compare the long-term survival and graft failure rates between OHT recipients of IRD and standard risk donors.
- To evaluate secondary outcomes including hospitalizations, infections, and rejection episodes in IRD recipients.
Main Methods:
- Analysis of the United Network of Organ Sharing (UNOS) registry data from 2004 to 2021.
- Dichotomization of OHT recipients based on Increased Risk Donor (IRD) status.
- Comparison of survival, graft failure, hospitalizations, infection rates, and rejection episodes between IRD and standard risk donor groups.
Main Results:
- 21% of 36,989 OHT recipients received organs from IRD.
- IRD recipients had shorter waitlist times and similar long-term survival and graft failure rates.
- IRD recipients demonstrated lower odds of rehospitalization due to infection (OR 0.893) and rejection (OR 0.849).
Conclusions:
- Orthotopic heart transplantation (OHT) with Increased Risk Donor (IRD) organs yields comparable long-term survival and graft failure rates to standard donor organs.
- Further research is warranted to elucidate the mechanisms behind observed differences in infection and rejection-related hospitalizations.
- The findings support the consideration of IRD organs to expand the donor pool for OHT.
Background:
Orthotopic Heart transplantation (OHT) is a definitive treatment for patients with advanced heart failure. Despite available evidence, recipients and some clinicians remain hesitant to accept organs from Increased Risk Donors (IRD). This study aims to report trends in acceptance of donors from IRD donors and long-term outcomes.
Methods:
This study is an analysis of OHT recipients captured in the United Network of Organ Sharing (UNOS) registry from 2004 to 2021. OHT recipients were dichotomized by IRD status. Primary objectives were to report survival following OHT and trends in IRD use. Secondary objectives included all-cause hospitalizations, hospitalizations for infection, treated rejection, and graft failure.
Results:
Of the 36,989 OHT recipients within the study period, 7779 (21%) were identified as recipients of IRD. Recipients of IRD were older (57 years vs 56 years, p ≤0.001), more likely to be African American (23% vs 21%, p = 0.006), blood group O (40% vs 38%, p = 0.02), have public insurance (52% vs 50%, p = 0.02), and have a BMI >30 (30% vs 29%, p = 0.003). IRD recipients had shorter waitlist time (69 days vs 76 days, p = 0.009) and similar long-term survival. IRD recipients also had lower odds of rehospitalization due to infection (OR 0.893, CI 0.842-0.947; p = 0.0002) and lower odds of rehospitalization due to rejection (OR 0.849, CI 0.782-0.921; p ≤0.001).
Conclusions:
In this large multicenter study, we report that recipients of IRD had similar long-term survival and incidence of graft failure as recipients of standard risk donors. Further analysis is needed to understand observed differences in outcomes of hospitalizations for infection and treated rejection.
