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New UNOS allocation system associated with no added benefit in waitlist outcomes and worse post-transplant survival in heart-kidney patients.
Francke, Michael; Wolfson, Aaron M; Fong, Michael W; Nattiv, Jonathan; Pandya, Kruti; Kawaguchi, Eric S; Villalon, Sylvia; Mroz, Mark; Sertic, Ashley; Cochran, Ashley; Ackerman, Mary Alice; Melendrez, Marie; Cartus, Rachel; Johnston, Kori Ann; Okonkwo, Kamso; Ferrall, Joel; DePasquale, Eugene C; Lee, Raymond; Vaidya, Ajay S.
Afiliação
  • Francke M; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
  • Wolfson AM; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California. Electronic address: aaron.wolfson@med.usc.edu.
  • Fong MW; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
  • Nattiv J; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
  • Pandya K; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
  • Kawaguchi ES; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Villalon S; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Mroz M; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Sertic A; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Cochran A; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Ackerman MA; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Melendrez M; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Cartus R; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Johnston KA; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Okonkwo K; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • Ferrall J; Keck School of Medicine, University of Southern California, Los Angeles, California.
  • DePasquale EC; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
  • Lee R; Department of Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; USC CardioVascular Institute, Los Angeles, California.
  • Vaidya AS; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
J Heart Lung Transplant ; 42(11): 1529-1542, 2023 11.
Article em En | MEDLINE | ID: mdl-37394021
ABSTRACT

BACKGROUND:

The 2018 United Network for Organ Sharing (UNOS) heart transplant policy change (PC) sought to improve waitlist risk stratification to decrease waitlist mortality and promote geographically broader sharing for high-acuity patients awaiting heart transplantation. Our analysis sought to determine the effect of the UNOS PC on outcomes in patients waiting for, or who have received, a heart-kidney transplantation.

METHODS:

We analyzed adult (≥18 years old), first-time, heart-only and heart-kidney transplant candidates and recipients from the UNOS Registry. Patients were divided into pre-PC (PRE October 18, 2016-May 30, 2018) and post-PC (POST October 18, 2018-May 30, 2020) groups for comparison. Competing risks analysis (subdistribution and cause-specific hazards analyses) was performed to assess for differences in waitlist death/deterioration or heart transplantation. One-year post-transplant survival was assessed with Kaplan-Meier and Cox analyses. We included an interaction term (policy era × heart ± kidney) in our analyses to evaluate the effect of PC on outcomes in heart-kidney patients.

RESULTS:

One-year post-transplant survival was similar (p = 0.83) for PRE heart-kidney and heart-only recipients, but worse (p < 0.001) for POST heart-kidney vs heart-only recipients. There was a policy-era interaction between heart-kidney and heart-only recipients (HR 1.92[1.04,3.55], p = 0.038) indicating a detrimental effect of policy on 1-year survival in POST vs PRE heart-kidney recipients. No added beneficial effect of PC on waitlist outcomes in heart-kidney vs heart-only candidates was observed.

CONCLUSIONS:

There was no added policy-era benefit on waitlist outcomes for heart-kidney candidates when compared to heart-only candidates. POST heart-kidney recipients experienced worse 1-year survival compared to PRE heart-kidney recipients with no policy effect on heart-only recipients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Coração / Transplante de Rim Tipo de estudo: Risk_factors_studies Limite: Adolescent / Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Coração / Transplante de Rim Tipo de estudo: Risk_factors_studies Limite: Adolescent / Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article