A comprehensive strategy in donor acceptance: Impact on pediatric waitlist and heart transplant outcomes.
Child
Child, Preschool
Female
Graft Survival
Heart Failure
/ surgery
Heart Transplantation
/ methods
Humans
Infant
Length of Stay
Male
Patient Acceptance of Health Care
Pediatrics
Respiration, Artificial
Retrospective Studies
Stroke Volume
Tissue Donors
Tissue and Organ Procurement
Treatment Outcome
Ventricular Function, Left
Waiting Lists
donor refusal
pediatric heart transplant
waitlist
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
14
04
2020
revised:
14
05
2020
accepted:
18
05
2020
pubmed:
15
6
2020
medline:
31
8
2021
entrez:
15
6
2020
Statut:
ppublish
Résumé
Significant inter- and intra-center practice variability is present in pediatric donor heart acceptability. This may contribute to variation in the donor refusal rate and may impact waitlist time, morbidity, mortality, and transplant rates. In order to reduce practice variability, our center developed and implemented a comprehensive strategy regarding donor acceptance in September 2017. The aim of this study was to assess the impact of this strategy on waitlist time and outcomes as well as early post-transplant outcomes. We performed a single-center, retrospective analysis of all pediatric (<18 years) patients listed for single-organ heart transplant at our center from September 2015 to September 2018. Patients were divided into those listed before (Group 1) and after implementation of the comprehensive strategy (Group 2). The primary end-point was waitlist time. Secondary end-points included waitlist removal due to death or clinical deterioration, donor refusals per listed patient, early post-transplant outcomes (graft failure, mechanical ventilation time, inotropic support, length of hospital stay) and 1-year post-transplant survival. Of 78 listed patients, 54 were transplanted (29 in Group 1), 9 were removed due to death or clinical deterioration (7 in Group 1) and 15 were removed due to clinical improvement (12 in Group 1). The waitlist time was significantly shorter in Group 2 (17 days, IQR 7-53) vs Group 1 (90 days, IQR 14-162); P = .006. The number of donor refusals was lower in Group 2 (1, IQR 0-2.2) vs Group 1 (4, IQR 2-19); P < .001. The percentage of refused donors with normal function (Left ventricular ejection fraction > 50%) was lower in Group 2 vs Group 1 (53% vs 84%; P < .001). Difference in removal from the waitlist for death or deterioration in Group 2 vs Group 1 (n = 2, 7% vs n = 7, 20%, P = .18) did not reach statistical significance. There was no difference in post-transplant outcomes between groups. The waitlist time and donor refusals significantly decreased after implementation of a comprehensive donor acceptance strategy without impacting transplant outcomes. This analysis supports the need for a comprehensive approach to donor organ acceptance within a pediatric transplant center.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13764Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Colvin M, Smith JM, Skeans MA, et al. OPTN/SRTR 2015 annual data report: heart. Am J Transplant. 2017;17(Suppl 1):286-356.
Khan AM, Green RS, Lytrivi ID, Sahulee R. Donor predictors of allograft utilization for pediatric heart transplantation. Transpl Int. 2016;29(12):1269-1275.
Schnier KE, Cox JC, McIntyre C, Ruhil R, Sadiraj V, Turgeon N. Transplantation at the nexus of behavioral economics and health care delivery. Am J Transplant. 2013;13(1):31-35.
Howard DH. Why do transplant surgeons turn down organs? A model of the accept/reject decision. J Health Econ. 2002;21(6):957-969.
Axelrod DA. Balancing accountable care with risk aversion: transplantation as a model. Am J Transplant. 2013;13(1):7-8.
Davies RR, Bano M, Butts RJ, Jaquiss RDB, Kirk R. Donor organ turn-downs and outcomes after listing for pediatric heart transplant. J Heart Lung Transplant. 2019;38(3):241-251.
Kobashigawa J, Zuckermann A, Macdonald P, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33(4):327-340.
Jeewa A, Manlhiot C, Kantor PF, Mital S, McCrindle BW, Dipchand AI. Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. J Thorac Cardiovasc Surg. 2014;147(1):462-468.
Kirk R, Dipchand AI, Davies RR, et al. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant. 2020;39(4):331-341.
Dipchand AI, Kirk R, Miera O, Davies RR. Accepting pediatric donor hearts: how do we make the best decision? Pediatr Transplant. 2020;24(3):e13670.
Denfield SW, Azeka E, Das B, et al. Pediatric cardiac waitlist mortality-Still too high. Pediatr Transplant. 2020;24(3):e13671.
Schweiger M, Everitt MD, Chen S, et al. Review of the discard and/or refusal rate of offered donor hearts to pediatric waitlisted candidates. Pediatr Transplant. 2020;24(3):e13674.
Conway J, Ballweg JA, Fenton M, et al. Review of the impact of donor characteristics on pediatric heart transplant outcomes. Pediatr Transplant. 2020;24(3):e13680.
McCulloch MA, Zuckerman WA, Möller T, et al. Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: a review of the literature. Pediatr Transplant. 2020;24(3):e13676.
Zimpfer D, Alexander PMA, Davies RR, et al. Pediatric donor management to optimize donor heart utilization. Pediatr Transplant. 2020;24(3):e13679.
Gossett JG, Amdani S, Khulbey S, et al. Review of interactions between high-risk pediatric heart transplant recipients and marginal donors including utilization of risk score models. Pediatr Transplant. 2020;24(3):e13665.
Butler A, Chapman G, Johnson JN, et al. Behavioral economics-A framework for donor organ decision-making in pediatric heart transplantation. Pediatr Transplant. 2020;24(3):e13655.
Conway J, Chin C, Kemna M, et al. Donors' characteristics and impact on outcomes in pediatric heart transplant recipients. Pediatr Transplant. 2013;17(8):774-781.
Rossano JW, Cherikh WS, Chambers DC, et al. The Registry of the International Society for Heart and Lung Transplantation: Twentieth Pediatric Heart Transplantation Report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36(10):1060-1069.
Banner NR, Thomas HL, Curnow E, et al. The importance of cold and warm cardiac ischemia for survival after heart transplantation. Transplantation. 2008;86(4):542-547.
Hollander SA, Schultz LM, Dennis K, et al. Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation. Pediatr Transplant. 2019;23(2):e13351.
VanderPluym CJ, Adachi I, Niebler R, et al. Outcomes of children supported with an intracorporeal continuous-flow left ventricular assist system. J Heart Lung Transplant. 2019;38(4):385-393.
Afshar S, Porter M, Barton B, Stormon M. Intellectual and academic outcomes after pediatric liver transplantation: relationship with transplant-related factors. Am J Transplant. 2018;18(9):2229-2237.
Anthony SJ, Annunziato RA, Fairey E, Kelly VL, So S, Wray J. Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care. Pediatr Transplant. 2014;18(5):423-434.
Feingold B, Webber SA, Bryce CL, et al. Cost-effectiveness of pediatric heart transplantation across a positive crossmatch for high waitlist urgency candidates. Am J Transplant. 2015;15(11):2978-2985.
Rana A, Fraser CD, Scully BB, et al. Inferior outcomes on the waiting list in low-volume pediatric heart transplant centers. Am J Transplant. 2017;17(6):1515-1524.
Davies RR, Haldeman S, Pizarro C. Regional variation in survival before and after pediatric heart transplantation-an analysis of the UNOS database. Am J Transplant. 2013;13(7):1817-1829.
Draaisma E, Bekhof J, Langenhorst VJ, Brand PLP. Implementing evidence-based medicine in a busy general hospital department: results and critical success factors. BMJ evidence-based Med. 2018;23(5):173-176.
Heilman RL, Green EP, Reddy KS, Moss A, Kaplan B. Potential impact of risk and loss aversion on the process of accepting kidneys for transplantation. Transplantation. 2017;101(7):1514-1517.
Easterwood R, Singh RK, McFeely ED, et al. Pediatric cardiac transplantation using hearts previously refused for quality: a single center experience. Am J Transplant. 2013;13(6):1484-1490.
Schold JD, Srinivas TR, Poggio ED, et al. Hidden selection bias deriving from donor organ characteristics does not affect performance evaluations of kidney transplant centers. Med Care. 2010;48(10):907-914.
Smith JW, O'Brien KD, Dardas T, et al. Systematic donor selection review process improves cardiac transplant volumes and outcomes. J Thorac Cardiovasc Surg. 2016;151(1):238-243.