Organ allocation and procurement in cardiac transplantation.
Journal
Current opinion in organ transplantation
ISSN: 1531-7013
Titre abrégé: Curr Opin Organ Transplant
Pays: United States
ID NLM: 9717388
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
entrez:
3
5
2021
pubmed:
4
5
2021
medline:
30
9
2021
Statut:
ppublish
Résumé
There is a critical shortage of organs in cardiac transplantation. Recent advancements in both organ allocation and donor utilization have intended to address this shortage and optimally allocate allografts. This review evaluates several important aspects of recipient and donor management. For recipients, the focus is placed on the evolving mechanical circulatory support population and its bidirectional impact on organ allocation. From the donor standpoint, organ utilization is assessed with respect to increasing access to previously unused allografts. Implementation of the new heart allocation system in the United States has better stratified waitlist candidates by illness acuity. Compared to the prior system, those requiring venoarterial extracorporeal membrane oxygenation support are less likely to die on the waitlist, although conflicting data exists whether this has improved their posttransplant survival. The use of pretransplant intra-aortic balloon pumps has markedly increased, whereas transplantation of patients with dischargeable left ventricular assist devices has decreased. Although some studies have reported inferior short- to mid-term posttransplant survival in the new system compared to its predecessor, others report similar outcomes.Several recent advancements in donor utilization have also been noted. Coinciding with the global increase in drug overdose deaths, efforts have been made to increase use of these donors who are frequently considered 'increased risk' and are hepatitis C-positive. Grafts from these donors appear safe to use. These, alongside donation after circulatory death donors, represent potentially underutilized populations that may effectively expand the donor pool. Recent changes in organ allocation, alongside efforts to expand the donor pool, have attempted to improve cardiac allograft utilization and reduce the imbalance between organ supply and demand. Ongoing monitoring and continuous re-evaluation of these efforts will help guide future practice.
Identifiants
pubmed: 33938464
doi: 10.1097/MOT.0000000000000872
pii: 00075200-202106000-00004
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
282-289Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
World Health Organization. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death . [Accessed 22 February 2021]
Colvin M, Smith JM, Ahn Y, et al. OPTN/SRTR 2019 annual data report: heart. Am J Transplant 2021; 21: (Suppl 2): 356–440.
Lindblad K, Goff RR. One-Year Monitoring of Heart Allocation Proposal to Modify the Heart Allocation System. 2020. https://optn.transplant.hrsa.gov/media/3701/data_report_thoracic_committee_heart_subcommittee_20200227_rpt1_revised_508_compliant.pdf . [Accessed 13 February 2021]
Singh TP, Almond CS, Taylor DO, et al. Decline in heart transplant wait-list mortality in the United States following broader regional sharing of donor hearts. Circ Heart Fail 2012; 5:249–258.
Meyer DM, Rogers JG, Edwards LB, et al. The future direction of the adult heart allocation system in the United States. Am J Transplant 2015; 15:44–54.
Cogswell R, John R, Estep JD, et al. An early investigation of outcomes with the new 2018 donor heart allocation system in the United States. J Heart Lung Transplant 2020; 39:1–4.
Jawitz OK, Fudim M, Raman V, et al. Reassessing recipient mortality under the new heart allocation system: an updated UNOS Registry Analysis. JACC Heart Fail 2020; 8:548–556.
Hanff TC, Harhay MO, Kimmel SE, et al. Update to an early investigation of outcomes with the new 2018 donor heart allocation system in the United States. J Heart Lung Transplant 2020; 39:725–726.
Kilic A, Hickey G, Mathier MA, et al. Outcomes of the First 1300 Adult Heart Transplants in the United States After the Allocation Policy Change. Circulation 2020; 141:1662–1664.
Liu J, Yang BQ, Itoh A, et al. Impact of new UNOS allocation criteria on heart transplant practices and outcomes. Transplant Direct 2020; 7:e642.
Goff RR, Uccellini K, Lindblad K, et al. A change of heart: preliminary results of the US 2018 adult heart allocation revision. Am J Transplant 2020; 20:2781–2790.
Estep JD, Soltesz E, Cogswell R. The new heart transplant allocation system: early observations and mechanical circulatory support considerations. J Thorac Cardiovasc Surg 2020; doi: 10.1016/j.jtcvs.2020.08.113. [Epub ahead of print].
doi: 10.1016/j.jtcvs.2020.08.113.
Kilic A, Mathier MA, Hickey GW, et al. Evolving trends in adult heart transplant with the 2018 heart allocation policy change. JAMA Cardiol 2021; 6:159–167.
Moonsamy P, Axtell AL, Ibrahim NE, et al. Survival after heart transplantation in patients bridged with mechanical circulatory support. J Am Coll Cardiol 2020; 75:2892–2905.
Barge-Caballero E, Almenar-Bonet L, Gonzalez-Vilchez F, et al. Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry. Eur J Heart Fail 2018; 20:178–186.
Gonzalez MH, Acharya D, Lee S, et al. Improved survival after heart transplantation in patients bridged with extracorporeal membrane oxygenation in the new allocation system. J Heart Lung Transplant 2021; 40:149–157.
Trivedi JR, Slaughter MS. ‘Unintended’ consequences of changes in heart transplant allocation policy: impact on practice patterns. ASAIO J 2020; 66:125–127.
Parker WF, Chung K, Anderson AS, et al. Practice changes at U.S. transplant centers after the new adult heart allocation policy. J Am Coll Cardiol 2020; 75:2906–2916.
Hess NR, Hickey GW, Sultan I, et al. Extracorporeal membrane oxygenation bridge to heart transplant: trends following the allocation change. J Card Surg 2020; doi: 10.1111/jocs.15118. [Epub ahead of print].
doi: 10.1111/jocs.15118.
Davies RR, Farr M, Silvestry S, et al. The new United States heart allocation policy: progress through collaborative revision. J Heart Lung Transplant 2017; 36:595–596.
Stevenson LW, Kormos RL, Young JB, et al. Major advantages and critical challenge for the proposed United States heart allocation system. J Heart Lung Transplant 2016; 35:547–549.
Stern LK, Velleca A, Nishihara K, et al. Impact of the United Network for organ sharing 2018 donor heart allocation system on transplant morbidity and mortality. Clin Transplant 2020; 4:e14181.
Huckaby LV, Seese LM, Mathier MA, et al. Intra-aortic balloon pump bridging to heart transplantation: impact of the 2018 allocation change. Circ Heart Fail 2020; 13:e006971.
Varshney AS, Berg DD, Katz JN, et al. Use of temporary mechanical circulatory support for management of cardiogenic shock before and after the United Network for Organ Sharing donor heart allocation system changes. JAMA Cardiol 2020; 5:703–708.
Goldstein DJ, Naka Y, Horstmanshof D, et al. Association of clinical outcomes with left ventricular assist device use by bridge to transplant or destination therapy intent: The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) Randomized Clinical Trial. JAMA Cardiol 2020; 5:411–419.
Rogers JG, Pagani FD, Tatooles AJ, et al. Intrapericardial left ventricular assist device for advanced heart failure. N Engl J Med 2017; 376:451–460.
Teuteberg JJ, Cleveland JC Jr, Cowger J, et al. The Society of Thoracic Surgeons Intermacs 2019 Annual Report: The Changing Landscape of Devices and Indications. Ann Thorac Surg 2020; 109:649–660.
Department of Health & Human Services: Determination that a public heath emergency exists. 2017. https://www.hhs.gov/sites/default/files/opioid%20PHE%20Declaration-no-sig.pdf . [Accessed 22 February 2021]
Organ Procurement and Transplantation Network: Deceased Donors Recovered in the U.S. by Mechanism of Death. 2021. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# . [Accessed 17 February 2021]
Phillips KG, Ranganath NK, Malas J, et al. Impact of the opioid epidemic on heart transplantation: donor characteristics and organ discard. Ann Thorac Surg 2019; 108:1133–1139.
Quintana-Quezada RA, Rajapreyar I, Postalian-Yrausquin A, et al. Clinical factors implicated in primary graft dysfunction after heart transplantation: a single-center experience. Transplant Proc 2016; 48:2168–2171.
Durand CM, Bowring MG, Thomas AG, et al. The drug overdose epidemic and deceased-donor transplantation in the United States: A National Registry Study. Ann Intern Med 2018; 168:702–711.
Ising MS, Gallo M, Whited WM, et al. Changing demographics of heart donors: the impact of donor drug intoxication on posttransplant survival. Am J Transplant 2018; 18:1790–1798.
Mehra MR, Jarcho JA, Cherikh W, et al. The drug-intoxication epidemic and solid-organ transplantation. N Engl J Med 2018; 378:1943–1945.
Organ Procurement and Transplantation Network. Understanding the Risk of Transmission of HIV, Hepatitis B, and Hepatitis C from U.S. PHS Increased Risk Donors. 2017. https://optn.transplant.hrsa.gov/media/2270/dtac_guidance_risks_201706.pdf . [Accessed 11 February 2021]
Okoh AK, Chan O, Schultheis M, et al. Association between increased-risk donor social behaviors and recipient outcomes after heart transplantation. Clin Transplant 2020; 34:e13787.
Shudo Y, Cohen JE, Lingala B, et al. Impact of ‘increased-risk’ donor hearts on transplant outcomes: a propensity-matched analysis. J Thorac Cardiovasc Surg 2019; 157:603–610.
Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health 2018; 108:175–181.
Chiu P, Robbins RC, Ha R. Heart Transplantation: Organ Procurement and Preservation - Donor Selection. In: Sabiston & Spencer Surgery of the Chest. 8th edition. Edited by Sellke FW, del Nido PJ, Swanson SJ, et al . Philadelphia: Saunders Elsevier; 2010. Chapter 98(4).
Zaroff JG, Rosengard BR, Armstrong WF, et al. Consensus conference report: maximizing use of organs recovered from the cadaver donor: cardiac recommendations, March 28-29, 2001, Crystal City, Va. Circulation 2002; 106:836–841.
Woolley AE, Singh SK, Goldberg HJ, et al. Heart and lung transplants from HCV infected donors to uninfected recipients. N Engl J Med 2019; 380:1606–1617.
Aslam S, Yumul I, Mariski M, et al. Outcomes of heart transplantation from hepatitis C virus–positive donors. J Heart Lung Transplant 2019; 38:1259–1267.
McLean RC, Reese PP, Acker M, et al. Transplanting hepatitis C virus-infected hearts into uninfected recipients: a single-arm trial. Am J Transplant 2019; 19:2533–2542.
Schlendorf KH, Zalawadiya S, Shah AS, et al. Expanding heart transplant in the era of direct-acting antiviral therapy for hepatitis C. JAMA Cardiol 2019; 5:167–174.
Bethea ED, Gaj K, Gustafson JL, et al. Preemptive pangenotypic direct acting antiviral therapy in donor HCV-positive to recipient HCV-negative heart transplantation: an open-label study. Lancet Gastroenterol Hepatol 2019; 4:771–780.
Dhital KK, Iyer A, Connellan M, et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet 2015; 385:2585–2591.
Messer S, Cernic S, Page A, et al. A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors. J Heart Lung Transplant 2020; 39:1463–1475.
Chew HC, Iyer A, Connellan M, et al. Outcomes of donation after circulatory death heart transplantation in Australia. J Am Coll Cardiol 2019; 73:1447–1459.
Jawitz OK, Raman V, DeVore AD, et al. Increasing the United States heart transplant donor pool with donation after circulatory death. J Thorac Cardiovasc Surg 2020; 159:e307–e309.