Adult Transplant Centers Research Articles

Esophageal Function Testing Patterns in the Evaluation and Management of Lung Transplantation: Results of a National Survey.

We surveyed esophageal motility laboratories affiliated with adult pulmonary transplant centers to determine esophageal function testing (EFT) practices. Gastroesophageal reflux and esophageal dysmotility are associated with worse lung transplant outcomes, yet no consensus guidelines for EFT exist in this population. A deidentified online survey was sent to gastrointestinal motility laboratory directors of 49 academic and community-affiliated medical centers that perform lung transplants. Practice characteristics, including annual lung transplant volume and institutional EFT practices pre-lung transplantation and post-lung transplantation were queried. Respondents were categorized by transplant volume into small and large programs based on median annual volume. Among 35 respondents (71% response rate), the median annual transplant volume was 37, and there were 18 large programs. Institutional EFT protocols were used pretransplant by 24 programs (68.6%) and post-transplant by 12 programs (34.2%). Among small and large programs, 52.9% and 72.2% always obtained high-resolution manometry before transplant, respectively. Endoscopy before transplant was performed more often in small programs (n=17, 100%) compared with large programs (n=15,83.3%). Pretransplant endoscopy ( P =0.04), barium esophagram ( P <0.01), and high-resolution manometry ( P =0.04) were more common than post-transplant. In contrast, post-transplant reflux monitoring off-therapy was more common than pretransplant ( P =0.01). In general, pulmonologists direct referrals for EFT and gastroenterology consultation (n=28, 80.0%), with symptoms primarily prompting testing. In the absence of established guidelines, substantial variability exists in pretransplant and post-transplant EFT, directed by pulmonologists. Standardized EFT protocols and gastroenterologist-directed management of esophageal dysfunction has potential to improve lung transplant outcomes.

Evaluating the yield of digital single operator cholangioscopy in posttransplant biliary strictures after unsuccessful guidewire placement with ERCP.

Strictures are the most common biliary complication after liver transplantation, and endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard in its management. Failure to cross the biliary anastomosis requires a repeated attempt with ERCP, referral for percutaneous transhepatic cholangiography (PTC) or surgery. We present our experience with the digital single operator cholangioscope (D-SOC) in achieving guidewire access in a liver transplant cohort with difficult biliary strictures who have failed conventional ERCP methods. This was a retrospective study involving two adult liver transplant centers servicing the two most populated states in Australia. Deceased-donor liver transplant recipients undergoing D-SOC for biliary strictures who have failed conventional methods to achieve biliary access were included. Between July 2017 to April 2022, eighteen patients underwent D-SOC after failing to achieve guidewire placement through standard ERCP techniques. Thirteen out of eighteen (72%) had successful guidewire placement with index D-SOC. Five of eighteen patients (28%) had unsuccessful guidewire placement with D-SOC. In two of these patients, use of D-SOC informed further endoscopic management, with one avoiding PTC and the other avoiding surgery. Two of the five patients required PTC and one patient was left unstented. Three patients developed post D-SOC cholangitis. D-SOC is effective at achieving guidewire access in post-liver transplant patients who fail conventional ERCP techniques and should be considered in the treatment algorithm as a step before PTC and surgery.

The Outcomes of Liver Transplantation in Highly Dependent Incapacitated Patients with Intellectual and Developmental Disabilities.

Background/Objectives: Data regarding the outcomes of liver transplantation in disabled, highly dependent, and legally incapacitated adults are scarce, likely due to the infrequency of these procedures in such populations. Multicenter studies in adult transplant centers have shown that patients with coexisting intellectual and developmental disabilities (IDDs) may be denied transplantation because of their expected low longevity and the complexities associated with managing post-transplant care. We examined the long-term patient and graft outcomes in highly dependent, incapacitated patients with IDDs who underwent elective transplantation for chronic liver disease. Methods: Six adult patients who underwent liver transplantation for primary biliary cholangitis (n = 2), hepatitis C cirrhosis (n = 2), Wilson's disease (n = 1), and autoimmune hepatitis (n = 1) were included. The main causes of their disability were infantile cerebral palsy, myotonia, and Niemann-Pick disease. Results: Four of the six patients were women, with a median age of 26 (range: 23-36) years. Only one patient died during follow-up. Their 1- and 5-year survival rates were 100 and 75%, respectively, which were not statistically different from those of the general cohort of electively transplanted patients (95.8 and 90.1%, respectively) (p = 0.35). Conclusions: Adult patients who are highly dependent, disabled, or legally incapable should not be denied liver transplantation because of poor long-term survival rates. Physiological disorders and psychiatric comorbidities should not prevent patients from receiving life-saving surgeries due to poor postoperative compliance or low quality of life.

Pediatric liver transplant recipients are not just young adults: The importance of a structured health care transition program in adult transplant centers.

Health care transition (HCT) is a vulnerable period that continues into adulthood, even after the transfer of care. Given the growing population of pediatric liver transplant recipients reaching young adulthood, the need for a standardized and multidisciplinary approach to transition that spans from pediatric to adult care is becoming more imperative. In this article, we review the unique challenges and barriers to successful HCT that adolescent and young adults (AYAs) who have undergone liver transplant face, highlight the gap in transition care in the adult setting, and present the Six Core Elements of Health Care Transition TM as a framework that can be used by adult providers to incorporate AYAs systematically and collaboratively into adult practice. Multidisciplinary HCT programs should be the standard of care for all AYAs with liver transplant, and while implementation is a necessary first step, ongoing efforts to increase awareness, funding, and research on HCTs into adulthood are needed.

Turkish Hematologists’ Preferences for Related Donor Selection: Results of a Multicenter Survey

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a widely utilized treatment for various hematological diseases. While selection criteria for unrelated donors are well established, there is a lack of consistency and standardization in the selection of related donors. This study investigated the current approach of hematologists to the selection of related donors at Turkish HSCT centers. The study employed a cross-sectional survey design, distributing a self-administered questionnaire to 95 adult and pediatric transplantation centers in Türkiye to investigate their approaches to related donor selection for allo-HSCT. The questionnaire collected data on various topics including the center’s experience in performing allo-HSCT, patient groups treated, number of allo-HSCT procedures conducted between 2015 and 2021, preferences for related donors, considerations in related donor selection (such as sex and past pregnancies), guidelines utilized for related donor selection, upper age limit for related donors, and the use of specialized advanced analyses for elderly donors. The response rate to the survey was 38.9%. Variability was observed across centers in terms of sex consideration and the impact of past pregnancies on related female donor rejection. Different guidelines were employed for related donor selection, with the European Bone Marrow Transplantation guidelines being the most commonly used. Regarding the upper age limit for related donors, 8.1% of centers accepted an upper age limit of 55 years, 48.7% preferred an upper age limit of 65 years, and 43.2% selected related donors aged 65 and above. The lack of standardized guidelines for related donor selection in HSCT centers leads to variability in criteria and potential risks. Collaboration among centers is essential to establish consensus and develop standardized protocols.

Extracorporeal photopheresis (ECP) in the treatment of chronic lung allograft dysfunction (CLAD): a prospective, multicentre, open-label, randomised controlled trial studying the addition of ECP to standard care in the treatment of bilateral lung transplant patients with CLAD (E-CLAD UK)

BackgroundLong-term survival after lung transplantation is limited compared with other organ transplants. The main cause is development of progressive immune-mediated damage to the lung allograft. This damage, which can develop...

Public Reporting of Heart Transplant Center Performance: Promoting Clarity or Causing Confusion?

BackgroundTransplant center report cards are publicly available and used by regulators, insurance payers, and importantly patients and families. ObjectivesIn this study, the authors sought to evaluate the variability in reported public performance ratings of pediatric and adult heart transplant centers. MethodsProgram-specific reports from the Scientific Registry of Transplant Recipients from 2017-2021 were used to evaluate stability, volatility, and reliability of 3 publicly reported ratings: waitlist survival (WS), getting to a faster transplant (FT), and post-transplantation graft failure (GF). ResultsThere were 112 adult and 55 pediatric centers. Over the study period, nearly all centers (98%) had at least 1 change in rating in at least 1 of the tiers. The average time to the first rating change of any magnitude was 12-18 months for all tiers and centers. For adult centers, the most volatile rating was WS (SD: 0.77), followed by GF (SD: 0.76) and then FT (SD: 0.57). For pediatric centers, the most volatile rating was WS (SD: 0.79), followed by both GF (SD: 0.66) and FT (SD: 0.68), which were equally volatile. All tiers except adult FT had an estimated Fleiss’s kappa <0.20, indicating poor agreement/consistency across the study period. In addition, the intraclass correlation coefficient for all tiers was <0.50, indicating poor reliability. ConclusionsThe current 5-tier reporting of transplant center performance is highly volatile and has poor reliability and consistency. Given the unintended and significant negative consequences these reports can have, critical revision of these ratings is warranted.

National survey of transplant pharmacist ambulatory care practices

AbstractIntroductionThere has been sustained growth in transplant pharmacist positions. However, the scope of pharmacist involvement, frequency of patient visits with a transplant pharmacist, and description of the transplant pharmacists' role in the ongoing management of transplant recipients have not been well described.ObjectiveTo determine the prevalence and role of transplant pharmacists in the management of transplant recipients in the ambulatory care setting.MethodsA 53‐question online survey was developed with the primary outcome being the incidence of solid organ transplant (SOT) programs with ambulatory care pharmacy services. Secondary outcomes included describing the scope of ambulatory transplant pharmacist activities for posttransplant recipients. The survey was distributed via transplant listservs and remained open from April 25, 2023 to May 27, 2023.ResultsA total of 174 responses were included for analysis, with 47 (27%) being partial responses. The total number of pediatric adult and pediatric transplant centers in the United States was 248 with a total number of 748 active programs, giving an estimated response rate of 23.8%. Of those, 93.7% reported having ambulatory transplant pharmacy services. The median of ambulatory care full‐time employees was 1 (interquartile range [IQR] 1–2) across the responding institutions. Transplant pharmacists were also involved in outpatient infusions (69.2%), immunization screening and administration (82.5%), telehealth services (57.0%), prescription refill authorization (61.0%) electronic medical record in‐basket, or equivalent messaging tasks (91.1%).ConclusionThe incidence of SOT pharmacist involvement in ambulatory care is overall high (93.7%). Analysis of this project allows for a better understanding of the landscape of SOT ambulatory care pharmacy services and can be used as an assessment for standard practice activities.

(1105) - Outcomes of Young Adults Undergoing Heart Transplant at Pediatric vs Adult Transplant Centers

(1105) - Outcomes of Young Adults Undergoing Heart Transplant at Pediatric vs Adult Transplant Centers

Esophageal Function and Reflux Evaluations in Lung Transplantation: A Nationwide Survey of UNOS-Accredited Transplant Centers in the United States.

Gastroesophageal reflux disease has been associated with worse lung transplant outcomes. We aimed to assess local practices for esophageal function testing (EFT) across transplant centers. This was a survey study of all United Network for Organ Sharing-accredited adult lung transplant centers regarding local EFT practice. Among 39/63 (60%) responded centers, 38.5% required any EFT (35.9% esophageal manometry, 15.4% pH monitoring, and 28.2% pH impedance), while another 28.2% may consider EFT based on symptoms. Five-year transplant volume was higher among centers requiring EFT (253 vs 159, P = 0.04). Only a minority of lung transplant centers routinely obtained EFT, supporting the need for guidelines for standardized reflux/esophageal assessment.

(87) A Less Restrictive Approach to Procuring Organs is Not an Indicator of Prognostic Survival in Heart Transplantation: A Retrospective Analysis of 118 Adult Heart Transplant Centers from 2020 to 2022

(87) A Less Restrictive Approach to Procuring Organs is Not an Indicator of Prognostic Survival in Heart Transplantation: A Retrospective Analysis of 118 Adult Heart Transplant Centers from 2020 to 2022

Substance use and solid organ transplantation in adolescents and young adults: Current findings and implications.

Understanding the role of substance use is important in the equitable allocation of solid organs and may present an opportunity for improving outcomes among substance users who receive transplants. This scoping review presents findings related to substance use among pediatric and young adult transplant populations and suggests future directions. A scoping review was conducted seeking studies related to substance use in pediatric and young adult transplant populations under the age of 39 years. Studies were deemed eligible if they collected data or addressed policy concerns and participants' mean age was below 39 years. Twenty-nine studies were identified as eligible for this review. Overall, policies around substance use are largely inconsistent throughout both pediatric and adult transplant centers. Findings indicated that substance use among pediatric and young adult transplant recipients is similar to or lower than healthy peers. Few studies addressed marijuana use and opioid misuse, among other substances. There is a general dearth of research on substance use in this population. The current findings suggest that substance use, although relatively less common, affects eligibility for transplant, may lead to poor outcomes, and affects medication adherence. Inconsistent substance use policies in transplant centers have the potential to result in bias. However, more research is needed on the effects of substance use among pediatric and young adult transplant candidates and recipients as well as on equitable policies for organ allocation for individuals who use substances.

The needle in the haystack: deciphering diagnostic data in a case of acute on chronic liver failure

The needle in the haystack: deciphering diagnostic data in a case of acute on chronic liver failure

Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service.

With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants. In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen. Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption. Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.

Handling of Allogeneic HPC Grafts in European Transplant Centers during the COVID-19 Pandemic - a Survey from the Infectious Diseases and Cellular Therapy & Immunobiology Working Parties of the EBMT

Background: For more than two years, the COVID-19 pandemic has had detrimental impact on medical practices. Because of its intrinsic complexity, the delivery of allogeneic hematopoietic cell transplantation (HCT) in this context represents an enormous challenge. Transplant centers have adapted promptly and developed strategies to enable safe HCT, by introducing significant changes in their procedures, e.g. through changes in donor types and an unprecedented use of cryopreservation for allogeneic hematopoietic progenitor cell (HPC) grafts. Methods: To explore how centers modified their strategies in terms of donor selection and implementation of new procedures (e.g. SARS-CoV-2 test strategy, cryopreservation), a 14-item survey was developed by the Infectious Disease (IDWP) & Cellular Therapy & Immunobiology (CTIWP) working parties of the European Society for Blood and Marrow Transplantation (EBMT). The survey was sent to 509 EBMT-affiliated allogeneic HCT in Q2, 2011 and re-opened between January 31st and March 18th, 2022 to also cover changes during to the infection period with the Omicron variant. Results: One hundred thirty-five of 509 (27%) centers from 31countries responded. Seventy-four percent of centers introduced COVID-19 mitigation measures for their donors (e.g. physical and social distancing) to minimize the risk of infection. Thirty-four percent of centers changed their donor search strategy, and favored recruitment of related haploidentical donors over unrelated donors (URD). In addition, 33% and 50% of centers searched for a backup donor in the related and URD settings, respectively. Only 10 (7.4 %) of centers resorted to cord blood (CB) as an alternative source to URD. Of these, four centers where pediatric centers and three, pediatric and adult transplant centers. Before COVID-19, only ten of 135 centers (7.4%) were routinely cryopreserving HPC products, whereas this percentage increased to 90% (122/135) during the pandemic. In details, 84/122 (69%) of centers cryopreserved both related and URD grafts, 34 (28%) only URD and 4 (3%) related grafts only. One hundred twenty centers responded during the re-opening of the survey to cover the situation during the Omicron wave. Of those, 78% were still considering graft cryopreservation, whereas 18/26 (70%) of centers not using cryopreservation during the Omicron wave used it before that period. In the majority of centers, changes in policies were introduced based on EBMT recommendations (88/117; 75%) and/or national guidelines (73/117; 62%). Bone marrow (BM) grafts were avoided by 52 (39%) centers (possibly because of the notorious low recovery percentage of cryopreserved BM progenitor cells). In the study period, a total of 4,443 related and 4,586 URD transplants have been reported. Of these transplants, 62% (n=2,748) related and 71% (n=3,254) of URD grafts have been cryopreserved pre-emptively and infused in the vast majority of cases. Sixty-four (2.3 %) related and hundred-eight (3.3 %) URD cryopreserved products have not been infused during the observation period. Release criteria for cryopreserved products in terms of COVID-19 were based on a negative SARS-CoV-2 test (not further specified) in 58/121 (48%), interview of the donor (medical history) in 4/121 (3%), and both in 38/121 (31%) of centers. Eighty-eight centers reported on their test strategy for related donors (multiple answers possible). A SARS-CoV-2 test was performed during check-up in 43% (38/88), before HPC mobilization in 63% (55/88) and before HPC collection in 41% (36/88) centers. Test strategies for URD were not covered by the survey. Conclusions: These data are limited by the low number of respondents, but show a historical increase in cryopreservation of allogeneic HPC grafts during the first three waves of the SARS-CoV-2 pandemic, more in URD than in related donor grafts. The use of BM decreased, and CB grafts were not used as an alternative at most centers. A significant proportion of cryopreserved products (2.8%) were not infused. The reason for this is under investigation. The clinical impact of allogeneic cryopreserved HPCs has to be further analyzed in a larger cohort of patients.

Attitudes & practices surrounding pregnancy post heart transplant among pediatric providers.

Many pediatric heart transplant (HT) recipients reach adulthood and may be interested in family planning; there is little data regarding safety of pregnancy post HT and clinicians' opinions differ. Pediatric HT clinicians are instrumental in early counseling. Thus, a better understanding of pediatric HT clinicians' practices regarding family planning and how well aligned these practices are with adult transplant centers is essential. We conducted a confidential, web-based survey of pediatric HT clinicians in fall 2021. We summarized and compared answers using Fisher's exact test. The survey was sent to 53 United States-based HT directors and to the International Society for Heart and Lung Transplantation and Pediatric Heart Transplant Society list serves. There were 69 respondents. The majority (77%) of respondents felt pregnancy was feasible in selected or all female HT recipients. Ten respondents reported that their institution had an established policy regarding pregnancy post HT. A majority (77%) of HT clinicians would either use a shared care model or recommend transition to their adult institution if pregnancy occurred, though 74% of respondents were either unaware of their corresponding adult institution's policy (62%) or had a counterpart adult program with a policy against pregnancy post HT (12%). While many clinicians feel pregnancy is feasible in pediatric HT recipients, there remains significant practice variation. Few pediatric programs have a policy regarding pregnancy post HT. Future efforts to provide consistent messaging between adult and pediatric HT programs regarding the feasibility and care of post HT pregnancy are warranted.

Current state of antimicrobial stewardship in solid organ transplantation in Israel.

We aimed to review the current state, challenges, and needs of antimicrobial stewardship programs (ASPs) in adult solid organ transplantation (SOT) centers in Israel. We conducted a survey using electronic questionnaires sent during February 2022 to infectious disease (ID) consultants of SOT centers, encompassing general and organ-specific ASP issues. All six centers performing adult SOTs in Israel participated. The institutional ASPs in all centers included SOT recipients, and five centers had specific stewardship activities targeting SOT recipients. ASP activities were performed by ID consultants in all centers, with clinical pharmacists in most. ASP protocols and activity scope were highly variable. Formulary restriction with pre-authorization was used in all centers. Antibiotic allergy was addressed in ASP guidelines in half of the centers. Peri-transplantation antibiotic, antifungal, and antiviral prophylactic regimens varied based on center, transplanted organ, and patient risk group. Approaches to surveillance cultures, diagnosis and treatment of various graft infections were also variable. ASP outcome measurement was not performed in all centers. The main challenges and barriers to successful ASP implementation were difficulty in defining appropriate durations of therapy for certain infections, high rates of antimicrobial resistance (AMR), and lack of dedicated ASP teams. Antimicrobial stewardship in SOT centers in Israel is performed by ID consultants and practices vary. Challenges are related to high AMR rates, insufficient evidence to support practices, lack of dedicated ASP teams, and lack of outcome measurement. There is an urgent need to establish a national collaborative program including all SOT centers.

Health Care Transition for Adolescents and Young Adults With Pediatric-Onset Liver Disease and Transplantation: A Position Paper by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition.

Advances in medical therapies and liver transplantation have resulted in a greater number of pediatric patients reaching young adulthood. However, there is an increased risk for medical complications and morbidity surrounding transfer from pediatric to adult hepatology and transplant services. Health care transition (HCT) is the process of moving from a child/family-centered model of care to an adult or patient-centered model of health care. Successful HCT requires a partnership between pediatric and adult providers across all disciplines resulting in a transition process that does not end at the time of transfer but continues throughout early adulthood. Joint consensus guidelines in collaboration with the American Society of Transplantation are presented to facilitate the adoption of a structured, multidisciplinary approach to transition planning utilizing The Six Core Elements of Health Care Transition TM for use by both pediatric and adult specialists. This paper provides guidance and seeks support for the implementation of an HCT program which spans across both pediatric and adult hepatology and transplant centers.

P1344: METHODOLOGY OF AN INTERNATIONAL MULTI-CENTER RETROSPECTIVE REVIEW OF TRANSPLANT-ASSOCIATED THROMBOTIC MICROANGIOPATHY (TA-TMA) BY THE TA-TMA WORKING GROUP

Background: Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious and potentially life-threatening complication after allogeneic hematopoietic cell transplantation (alloHCT). Multiple sets of clinical diagnostic criteria for TA-TMA have been developed in adult and pediatric settings based on single-institution chart review or expert panels, but none have been rigorously evaluated across multiple centers to assess validity or reproducibility. The TA-TMA Working Group is conducting a multi-national, multi-center, retrospective study to identify and confirm potential adult and pediatric cases of TA-TMA. The aim of creating a large cohort of adjudicated TA-TMA cases is to better understand the incidence, risk factors, clinical outcomes, and healthcare resource utilization (HRU) associated with this condition. Aims: To describe the multiple-adjudication methodology employed to confirm diagnosis of TA-TMA across adult and pediatric transplant centers. Methods: Twelve US and EU centers retrospectively screened medical records of patients who received alloHCT between 2015 and 2017 using 5 criteria: schistocytosis (>2 per high-power field); LDH level above ULN; doubling of baseline creatinine; platelet refractoriness (50% decrease in platelet count and/or platelet count less than individual center’s transfusion threshold x 4 days despite transfusions); and decreased haptoglobin. Cases meeting ≥3 criteria within a 10-day period during the first 12 months after alloHCT were considered potential TA-TMA and were further evaluated by 2 clinicians from each transplant center. Patients who had a positive biopsy, were diagnosed with TA-TMA or aHUS, or had received eculizumab following alloHCT were considered to have definite TA-TMA. Of all positive cases determined by local adjudications, 30% will be randomly selected for central adjudication by independent adult and pediatric adjudication committees. Central adjudicators have access to relevant laboratory and radiologic data. In cases with 2 discordant decisions, a third central adjudicator will be assigned to break the tie. In cases of 3 discordant decisions regarding the diagnosis of TA-TMA, the case will be forwarded for discussion led by the central adjudication chair. All cases determined as positive TA-TMA after local and central adjudication will be aggregated and analyzed to evaluate clinical outcomes, risk factors for TA-TMA, disease course, survival and non-relapse mortality, and HRU. Results: As of March 1, 2022, 3,732 cases have been screened at 11 transplant centers and 836 were considered potential TA-TMA that met ≥3 criteria. To date, local adjudication at 8 centers determined 179 cases were positive TA-TMA. Due to variations in laboratory standards at different centers, a challenge encountered in this study was harmonization of screening criteria. For example, labs at several centers did not quantify number of schistocytes as part of their CBC, which restricted screening of potential TA-TMA cases to 4 criteria, leading to some cases being categorized as “unknown.” These outcomes highlight the differences in assessing TA-TMA at multiple centers. Summary/Conclusion: This is the first multi-center comprehensive retrospective study to evaluate TA-TMA with a formalized process for independent local and central adjudication to verify TA-TMA diagnosis. The large cohort of TA-TMA cases identified in this study should enable validation of current and future diagnostic criteria, improve our understanding of prognostic/risk factors, and enhance awareness of this disease.

UK National DCD Heart Transplant Program - First Year Experience

Purpose The donation after circulatory death (DCD) pathway is an emerging contributor to heart transplantation. Selected UK centres started their adult programs in 2015, followed by a centrally funded national pilot commencing September 2020. The purpose of this study is to review the activity and outcomes of the UK National DCD heart transplant program during this pilot. Methods Data on DCD heart transplants between September 2020 to August 2021 were extracted from the UK Transplant Registry, held by National Health Service Blood and Transplant. The Registry contains data on all offered organs from potential donors, proceeding donations and organ recipients. Additional data were collected on the DCD Heart travel document. The DCD hearts were procured by 3 specialist retrieval teams, with national organ allocation to all 7 adult and paediatric heart transplant centres. Endpoints The hearts of 143 potential DCD donors were referred for offering during this 12-month period, from all areas of the UK. This resulted in 77 acceptance, 60 retrievals, 33 hearts retrieved and 30 transplants. Direct procurement and machine perfusion was the technique used for all DCD heart retrievals with 2 hearts retrieved during abdominal normothermic regional perfusion. Six procurements were performed by a hybrid team consisting of members from 2 retrieval teams, and 21 were transplanted by a different centre to that of the retrieval team. Median donor and recipient age was 33 (range: 12-50) and 46 (range: 13-62), respectively. Seven recipients were super-urgent and 13 were urgent; with a median wait time of 20 days (range: 1-320). In the same period there were 105 adult and 18 paediatric donation after brain death (DBD) heart transplants; DCDs representing 19% and 22% of the programs, respectively. Two patients died within 30 days, making the 30-day survival rate 93.3% (95% CI: 76-98), similar to the DBD cohort. Extracorporeal membrane oxygenation in the first 30 days was required for 15 out of 30 transplants. Conclusion In the 12-month pilot, DCD heart transplantation was 20% of the total heart transplant activity. This UK wide program was underpinned by unprecedented collaboration between UK cardiothoracic teams, and with abdominal teams, improving communication and shared learning. High volume, specialised procurement teams are key to a successful DCD heart sharing program to overcome challenges from the learning curve. The donation after circulatory death (DCD) pathway is an emerging contributor to heart transplantation. Selected UK centres started their adult programs in 2015, followed by a centrally funded national pilot commencing September 2020. The purpose of this study is to review the activity and outcomes of the UK National DCD heart transplant program during this pilot. Data on DCD heart transplants between September 2020 to August 2021 were extracted from the UK Transplant Registry, held by National Health Service Blood and Transplant. The Registry contains data on all offered organs from potential donors, proceeding donations and organ recipients. Additional data were collected on the DCD Heart travel document. The DCD hearts were procured by 3 specialist retrieval teams, with national organ allocation to all 7 adult and paediatric heart transplant centres. The hearts of 143 potential DCD donors were referred for offering during this 12-month period, from all areas of the UK. This resulted in 77 acceptance, 60 retrievals, 33 hearts retrieved and 30 transplants. Direct procurement and machine perfusion was the technique used for all DCD heart retrievals with 2 hearts retrieved during abdominal normothermic regional perfusion. Six procurements were performed by a hybrid team consisting of members from 2 retrieval teams, and 21 were transplanted by a different centre to that of the retrieval team. Median donor and recipient age was 33 (range: 12-50) and 46 (range: 13-62), respectively. Seven recipients were super-urgent and 13 were urgent; with a median wait time of 20 days (range: 1-320). In the same period there were 105 adult and 18 paediatric donation after brain death (DBD) heart transplants; DCDs representing 19% and 22% of the programs, respectively. Two patients died within 30 days, making the 30-day survival rate 93.3% (95% CI: 76-98), similar to the DBD cohort. Extracorporeal membrane oxygenation in the first 30 days was required for 15 out of 30 transplants. In the 12-month pilot, DCD heart transplantation was 20% of the total heart transplant activity. This UK wide program was underpinned by unprecedented collaboration between UK cardiothoracic teams, and with abdominal teams, improving communication and shared learning. High volume, specialised procurement teams are key to a successful DCD heart sharing program to overcome challenges from the learning curve.