Original articleAdult cardiacMatching High-Risk Recipients With Marginal Donor Hearts Is a Clinically Effective Strategy
Section snippets
Data Collection
This study has been approved by our university's Institutional Review Board (IRB-AAAB8495), and the use of these data is consistent with the UNOS data use agreement. The standard transplant analysis and research dataset was provided by UNOS (data source 021606-4) and is de-identified patient-level data. It contains information collected from the UNetsm forms, including the transplant candidate registration form, the transplant recipient registration form, and the transplant recipient follow-up
Study Population
Analysis included 13,024 (Table 1) recipients stratified by recipient and donor characteristics into four categories: STD (n = 9,642, 74.0%), SR:MD (n = 970, 7.5%), HR:SD (n = 2,065, 15.9%), and ALT (n = 347, 2.7%).
Survival
As expected, survival in the standard transplant group was better than in all other groups (p ω 0.001; Fig 1). Although 30-day survival was similar between all of the nonstandard groups (SR:MD, HR:SD, ALT), survival was worst in the ALT group by 1 year (p ω 0.001). Survival for the
Comment
The burden related to heart failure continues to grow. Unfortunately, treatment options remain limited. Medical management ameliorates symptoms and prolongs survival in mild to moderate heart failure, but it does not treat the underlying pathology; therefore, with medical therapy alone, disease remains progressive and typically leads to death [9, 10]. Left ventricular assist devices offer a promising alternative, but long-term survival remains limited and adverse events are substantial.
References (14)
- et al.
Outcomes with an alternate list strategy for heart transplantation
J Heart Lung Transplant
(2005) - et al.
Alternate waiting list strategies for heart transplantation maximize donor organ utilization
Ann Thorac Surg
(2005) - et al.
Use of two recipient lists for adults requiring heart transplantation
J Thorac Cardiovasc Surg
(2003) - et al.
Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006
J Heart Lung Transplant
(2006) - et al.
The cost of medical management in advanced heart failure during the final two years of life
J Card Fail
(2008) - et al.
Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors
J Am Coll Surg
(2004) - et al.
Postlung transplant survival is equivalent regardless of cytomegalovirus match status
Ann Thorac Surg
(2007)