Impact of Donor Sequence Number on Survival Following Heart Transplantation

Abstract

Purpose With demand for organs greatly exceeding availability, expanded and safe organ acceptance may offer a means of improving heart transplantation access. Donor sequence number (DSN) has been considered to indicate organ desirability, with high numbers reflecting potentially high-risk features. We sought to evaluate the effect of high DSN on post-transplantation outcomes using a large national cohort. Methods Merged with the Potential Transplant Recipient File, the United Network for Organ Sharing database was used to identify isolated orthotopic heart transplantation recipients from 2001-2018. Only match runs with survival data were considered while recipients 90th percentile) for each year. A previously validated risk index incorporating donor features was used to quantify the risk of each organ. 30-day and 1-year adjusted survival were evaluated using Kaplan-Meier survival and Cox proportional hazards. Results Of 34,770 implanted organs, 3,549 (10.2%) were HDSN. The mean DSN at acceptance increased significantly during the study period (10.7 in 2001 to 18.8 in 2018, NP Conclusion Patients accepted at the highest sequence number demonstrated non-inferior short- and long-term survival outcomes. Transplant centers should be encouraged to accept higher-sequence grafts in selected patients.