Accepting Increased-Risk Donor Heart Tied to Higher Survival
TUESDAY, Oct. 30, 2018 -- Acceptance of a heart from an increased-risk donor (IRD) is associated with a significant survival benefit, according to a research letter published in the November issue of the Journal of the American College of Cardiology.
Michael S. Mulvihill, M.D., from Duke University Medical Center in Durham, North Carolina, and colleagues used data from the United Network of Organ Sharing for adult isolated heart transplant candidates who received an offer for an IRD allograft from 2007 to 2017. Candidates who declined an IRD offer were followed from the time of response until eventual IRD or non-IRD heart transplant, death or decompensation precluding heart transplant, or administrative censoring. Survival was compared between those accepting and declining IRD.
The researchers found that 2,602 IRD allografts were offered to 10,851 candidates. Among those who declined the IRD offer, 58 percent underwent non-IRD heart transplant, 12.4 percent underwent later IRD heart transplant, 7.9 percent were removed from the wait-list because of death or decompensation, and 21.1 percent were still awaiting transplant at one year post-offer. At one year from IRD offer, based on stratified, Cox-adjusted estimates, 92.1 percent of those who accepted and 83.1 percent of those who declined survived. This survival benefit persisted through five years post-offer. The adjusted restricted mean survival time (RMST) model favored acceptance, with RMST of 4.31 years for the accept group versus 3.84 years for the decline group.
"Increased utilization of IRD offers represents a rare opportunity to decrease waitlist mortality in cardiac transplantation," conclude the authors.
One author disclosed ties to the pharmaceutical industry.
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Posted: October 2018