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

The role of failure to rescue (FTR) in solid organ transplantation (SOT) is less clear. This scoping review aimed to evaluate the incidence, complications, and risk factors for FTR in SOT.

We systematically searched PubMed, Scopus, and Web of Science for studies reporting on FTR in SOT. Data on incidence, complications, risk factors, and definitions were extracted and synthesized narratively due to heterogeneity across studies.

Seven studies were identified: four in liver transplantation, two in lung transplantation, and one in heart transplantation; none addressed kidney or pancreas transplantation. Definitions of FTR varied by time window, complication set, and analytic unit. Reported FTR rates ranged from 4.6% to 39.6% in liver, 19% to 26% in lung, and 11.5% in heart transplantation. Across organs, dialysis-requiring acute kidney injury (AKI) was the most frequent proximate pathway to death. Risk signals spanned patient-level factors (age, comorbidities, frailty/sarcopenia, functional status), donor factors (age, sex, race/ethnicity), and system-level factors (center volume, mortality tertile, insurance coverage). Notably, heart transplantation data revealed higher adjusted odds of FTR among Hispanic recipients.

Evidence on FTR in transplantation remains sparse and heterogeneous, but early findings suggest that both patient vulnerability and system capacity shape rescue outcomes, with AKI consistently emerging as a cross-organ target. Standardized definitions, multicenter analyses, and extension to kidney and pancreas transplantation are needed to establish FTR as a transplant-specific quality metric and to guide interventions that optimize rescue.