Impact of Age of Heart Transplant Program on Patient Survival and Post‐Transplant Outcomes
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2024
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| author | David T. Majure Gabriel Sayer Kevin J. Clerkin Maria G. Karas Mandisa Jones Evelyn M. Horn Yoshifumi Naka Nir Uriel |
| author_facet | David T. Majure Gabriel Sayer Kevin J. Clerkin Maria G. Karas Mandisa Jones Evelyn M. Horn Yoshifumi Naka Nir Uriel David T. Majure Gabriel Sayer Kevin J. Clerkin Maria G. Karas Mandisa Jones Evelyn M. Horn Yoshifumi Naka Nir Uriel |
| collection | Wiley Open Access |
| contents | Impact of Age of Heart Transplant Program on Patient Survival and Post‐Transplant Outcomes David T. Majure Gabriel Sayer Kevin J. Clerkin Maria G. Karas Mandisa Jones Evelyn M. Horn Yoshifumi Naka Nir Uriel Clinical Transplantation ABSTRACTBackgroundThe relationship between age of a heart transplant (HT) program and outcomes has not been explored.MethodsWe performed a retrospective cohort analysis of the United Network for Organ Sharing database of all adult HTs between 2009 and 2019. For each patient, we created a variable that corresponded to program age: new (<5), developing (≥5 but <10) and established (≥10) years.ResultsOf 20 997 HTs, 822 were at new, 908 at developing, and 19 267 at established programs. Patients at new programs were significantly more likely to have history of cigarette smoking, ischemic cardiomyopathy, and prior sternotomy. These programs were less likely to accept organs from older donors and those with a history of hypertension or cigarette use. As compared to patients at new programs, transplant patients at established programs had less frequent rates of treated rejection during the index hospitalization (HR 0.43 [95% CI, 0.36–0.53] p < 0.001) and at 1 year (HR 0.58 [95% CI, 0.49–0.70], p < 0.001), less frequently required pacemaker implantations (HR 0.50 [95% CI, 0.36–0.69], p < 0.001), and less frequently required dialysis (HR 0.66 [95% CI, 0.53–0.82], p < 0.001). However, there were no significant differences in short‐ or long‐term survival between the groups (log‐rank p = 0.24).ConclusionPatient and donor selection differed between new, developing, and established HT programs but had equivalent survival. New programs had increased likelihood of treated rejection, pacemaker implantation, and need for dialysis. Standardized post‐transplant practices may help to minimize this variation and ensure optimal outcomes for all patients. 10.1111/ctr.15387 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.15387 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_15387 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Impact of Age of Heart Transplant Program on Patient Survival and Post‐Transplant Outcomes David T. Majure Gabriel Sayer Kevin J. Clerkin Maria G. Karas Mandisa Jones Evelyn M. Horn Yoshifumi Naka Nir Uriel Clinical Transplantation Impact of Age of Heart Transplant Program on Patient Survival and Post‐Transplant Outcomes David T. Majure Gabriel Sayer Kevin J. Clerkin Maria G. Karas Mandisa Jones Evelyn M. Horn Yoshifumi Naka Nir Uriel Clinical Transplantation ABSTRACTBackgroundThe relationship between age of a heart transplant (HT) program and outcomes has not been explored.MethodsWe performed a retrospective cohort analysis of the United Network for Organ Sharing database of all adult HTs between 2009 and 2019. For each patient, we created a variable that corresponded to program age: new (<5), developing (≥5 but <10) and established (≥10) years.ResultsOf 20 997 HTs, 822 were at new, 908 at developing, and 19 267 at established programs. Patients at new programs were significantly more likely to have history of cigarette smoking, ischemic cardiomyopathy, and prior sternotomy. These programs were less likely to accept organs from older donors and those with a history of hypertension or cigarette use. As compared to patients at new programs, transplant patients at established programs had less frequent rates of treated rejection during the index hospitalization (HR 0.43 [95% CI, 0.36–0.53] p < 0.001) and at 1 year (HR 0.58 [95% CI, 0.49–0.70], p < 0.001), less frequently required pacemaker implantations (HR 0.50 [95% CI, 0.36–0.69], p < 0.001), and less frequently required dialysis (HR 0.66 [95% CI, 0.53–0.82], p < 0.001). However, there were no significant differences in short‐ or long‐term survival between the groups (log‐rank p = 0.24).ConclusionPatient and donor selection differed between new, developing, and established HT programs but had equivalent survival. New programs had increased likelihood of treated rejection, pacemaker implantation, and need for dialysis. Standardized post‐transplant practices may help to minimize this variation and ensure optimal outcomes for all patients. 10.1111/ctr.15387 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Impact of Age of Heart Transplant Program on Patient Survival and Post‐Transplant Outcomes |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15387 |