Impact of Center Donor Acceptance Patterns on Utilization of Extended-Criteria Donors and Outcomes

Abstract

Background: This study investigated the impact of transplanting center\ndonor acceptance patterns on usage of extended-criteria donors (ECDs)\nand posttransplant outcomes following orthotopic heart transplantation\n(OHT). Methods: The Scientific Registry of Transplant Recipients was\nqueried to identify heart donor offers and adult, isolated OHT\nrecipients in the United States from 1/1/2013-10/17/2018. Centers were\nstratified into 3 equal-size terciles based on donor heart acceptance\nrates (<13.7%, 13.7%-20.2%, >20.2%). Overall\nsurvival was compared between recipients of ECDs (≥40 years, left\nventricular ejection fraction <60%, distance ≥500 miles,\nhepatitis B, hepatitis C or human immunodeficiency virus, or ≥50 offers)\nand recipients of traditional-criteria donors, and among transplanting\nterciles. Results: A total of 85,505 donor heart offers were made to 133\ncenters with 15,264 (17.9%) accepted for OHT. High-acceptance programs\n(>20.2%) more frequently accepted donors with LVEF\n<60%, HIV, HCV, and/or HBV, ≥50 offers, or distance\n>500 miles from the transplanting center (each\np<0.001). Posttransplant survival was comparable across all\nthree terciles (p=0.11). One- and five-year survival were also similar\nacross terciles when examining recipients of all five ECD factors.\nAcceptance tier and increasing acceptance rate were not found to have\nany impact on mortality in multivariable modeling. Of ECD factors, only\nage ≥40 years was found to have increased hazards for mortality (HR\n1.33, 95% CI 1.22-1.46, p<0.001). Conclusions: Of recipients\nof ECD hearts, outcomes are similar across center-acceptance terciles.\nEducating less aggressive programs to increase donor acceptance and ECD\nutilization may yield higher national rates of OHT without major impact\non outcomes.