Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation
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Wiley
2024
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| author | Yeahwa Hong Nidhi Iyanna Nicholas R. Hess Luke A. Ziegler Mohamed Abdullah Ander Dorken‐Gallastegi Michael A. Mathier Mary E. Keebler Gavin W. Hickey David J. Kaczorowski |
| author_facet | Yeahwa Hong Nidhi Iyanna Nicholas R. Hess Luke A. Ziegler Mohamed Abdullah Ander Dorken‐Gallastegi Michael A. Mathier Mary E. Keebler Gavin W. Hickey David J. Kaczorowski Yeahwa Hong Nidhi Iyanna Nicholas R. Hess Luke A. Ziegler Mohamed Abdullah Ander Dorken‐Gallastegi Michael A. Mathier Mary E. Keebler Gavin W. Hickey David J. Kaczorowski |
| collection | Wiley Open Access |
| contents | Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation Yeahwa Hong Nidhi Iyanna Nicholas R. Hess Luke A. Ziegler Mohamed Abdullah Ander Dorken‐Gallastegi Michael A. Mathier Mary E. Keebler Gavin W. Hickey David J. Kaczorowski Clinical Transplantation ABSTRACTBackgroundThis study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.MethodsThe UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist. The incidence of waitlist transfusion was compared before and after the 2018 allocation policy change. The primary outcome was survival. Propensity score‐matching was performed. Multivariable logistic regression was performed to identify predictors of waitlist transfusion. A sub‐analysis was performed to evaluate the impact of waitlist time on waitlist transfusion.ResultsFrom the 21 926 recipients analyzed in this study, 4201 (19.2%) received waitlist transfusion. The incidence of waitlist transfusion was lower following the allocation policy change (14.3% vs. 23.7%, p < 0.001). The recipients with waitlist transfusion had significantly reduced 1‐year posttransplant survival (88.8% vs. 91.9%, p < 0.001) compared to the recipients without waitlist transfusion in an unmatched comparison. However, in a propensity score‐matched comparison, the two groups had similar 1‐year survival (90.0% vs. 90.4%, p = 0.656). Multivariable analysis identified ECMO, Impella, and pretransplant dialysis as strong predictors of waitlist transfusion. In a sub‐analysis, the odds of waitlist transfusion increased nonlinearly with longer waitlist time.ConclusionThere is a lower incidence of waitlist transfusion among transplant recipients under the 2018 allocation system. Waitlist transfusion is not an independent predictor of adverse posttransplant outcomes but rather a marker of the patient's clinical condition. ECMO, Impella, and pretransplant dialysis are strong predictors of waitlist transfusion. 10.1111/ctr.15422 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1111/ctr.15422 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_15422 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation Yeahwa Hong Nidhi Iyanna Nicholas R. Hess Luke A. Ziegler Mohamed Abdullah Ander Dorken‐Gallastegi Michael A. Mathier Mary E. Keebler Gavin W. Hickey David J. Kaczorowski Clinical Transplantation Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation Yeahwa Hong Nidhi Iyanna Nicholas R. Hess Luke A. Ziegler Mohamed Abdullah Ander Dorken‐Gallastegi Michael A. Mathier Mary E. Keebler Gavin W. Hickey David J. Kaczorowski Clinical Transplantation ABSTRACTBackgroundThis study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.MethodsThe UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist. The incidence of waitlist transfusion was compared before and after the 2018 allocation policy change. The primary outcome was survival. Propensity score‐matching was performed. Multivariable logistic regression was performed to identify predictors of waitlist transfusion. A sub‐analysis was performed to evaluate the impact of waitlist time on waitlist transfusion.ResultsFrom the 21 926 recipients analyzed in this study, 4201 (19.2%) received waitlist transfusion. The incidence of waitlist transfusion was lower following the allocation policy change (14.3% vs. 23.7%, p < 0.001). The recipients with waitlist transfusion had significantly reduced 1‐year posttransplant survival (88.8% vs. 91.9%, p < 0.001) compared to the recipients without waitlist transfusion in an unmatched comparison. However, in a propensity score‐matched comparison, the two groups had similar 1‐year survival (90.0% vs. 90.4%, p = 0.656). Multivariable analysis identified ECMO, Impella, and pretransplant dialysis as strong predictors of waitlist transfusion. In a sub‐analysis, the odds of waitlist transfusion increased nonlinearly with longer waitlist time.ConclusionThere is a lower incidence of waitlist transfusion among transplant recipients under the 2018 allocation system. Waitlist transfusion is not an independent predictor of adverse posttransplant outcomes but rather a marker of the patient's clinical condition. ECMO, Impella, and pretransplant dialysis are strong predictors of waitlist transfusion. 10.1111/ctr.15422 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15422 |