Understanding Failure to Rescue in Solid Organ Transplantation: A Scoping Review

Area of Science:

• Transplantation Medicine
• Health Services Research
• Critical Care

Background:

• The role of failure to rescue (FTR) in solid organ transplantation (SOT) requires further elucidation.
• Existing research on FTR in SOT is limited and lacks standardization.

Purpose of the Study:

• To conduct a scoping review evaluating the incidence, complications, and risk factors associated with FTR in SOT.
• To synthesize current evidence on FTR across different SOT types.

Main Methods:

• Systematic literature search across PubMed, Scopus, and Web of Science.
• Narrative synthesis of extracted data due to study heterogeneity.
• Focus on studies reporting FTR in liver, lung, and heart transplantation.

Main Results:

• Seven studies met inclusion criteria; none focused on kidney or pancreas transplantation.
• FTR definitions varied significantly, impacting reported incidence rates (4.6%-39.6% for liver, 19%-26% for lung, 11.5% for heart).
• Dialysis-requiring acute kidney injury (AKI) was a common pathway to death; patient, donor, and system factors influenced FTR risk, with higher odds in Hispanic heart transplant recipients.

Conclusions:

• Evidence on FTR in transplantation is sparse and heterogeneous.
• Patient vulnerability and healthcare system capacity are key determinants of rescue outcomes.
• Standardized definitions and broader study inclusion (kidney, pancreas) are crucial for developing FTR as a quality metric.