United Network Of Organ Sharing Research Articles

Challenges in Heart Transplantation in the Era of COVID-19.

Challenges in Heart Transplantation in the Era of COVID-19.

Clinical Outcomes and Quality of Life With an Ambulatory Counterpulsation Pump in Advanced Heart Failure Patients: Results of the Multicenter Feasibility Trial.

The NuPulseCV intravascular ventricular assist system (iVAS) provides extended duration ambulatory counterpulsation via a durable pump placed through the distal subclavian artery. We performed a prospective, single-arm, multicenter, US Food and Drug Administration-approved feasibility trial of iVAS therapy as a bridge to transplant or decision following the FIH (First-In-Human) trial. Forty-seven patients were enrolled, and 45 patients (median 61 years old, 37 males, and 30 listed on United Network of Organ Sharing) received iVAS support for median 44 (25-87) days. There were no intraoperative complications. Success was defined as survival or transplant on iVAS therapy free from disabling stroke. Outcome success at 30 days (the primary end point of this study) and at 6 months was 89% and 80%, respectively. During 6 months of iVAS support, 2 patients died and 2 patients experienced disabling neurological dysfunction. Six-minute walk distance, 2-minute step test, and Kansas City Cardiomyopathy Questionnaire score improved during 4-week iVAS support. This feasibility trial demonstrated promising short-term outcomes of iVAS therapy with improved functional capacity and quality of life during the therapy. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02645539.

Heart Retransplantation Outcomes before and after the UNOS Donor Heart Allocation Policy Change

To compare heart retransplantation (reHTx) mortality six months before and after the United Network of Organ Sharing (UNOS) donor heart allocation policy change to determine if the new allocation process may correlate to a difference in mortality. Using the UNOS Organ Registry we compared mortality rates for patients undergoing reHTx 6 months before and after the initiation of the UNOS allocation policy change with a multivariate Cox proportional hazard regression model adjusting for age, sex, race, diabetes diagnosis, ischemic time, need for dialysis/life support, recipient wait-time, and HLA mismatch. We excluded patients who were age <10, lost-to-follow-up, and multi-organ transplant recipients. Data was censored at 6 months. There were a total of 31 patients who underwent reHTx 6-months prior to the UNOS allocation system change and 24 patients 6 months after the change. The total days on the waiting list was significantly longer prior to the UNOS allocation change at 52.0 vs 12.5 days after the change (p=0.005). There was no statistically significant difference in mortality rates between recipients 6 months pre- and post-UNOS allocation policy change, 11.5% vs 30.5% (p=0.2960) respectively. Under the new UNOS donor heart allocation policy, patients requiring reHTx have shorter wait list times and no significant difference in mortality compared to the previous allocation system.

Comparison of Six-Month Outcomes in Patients Bridged to Heart Transplantation with an Intra-Aortic Balloon Pump before and after the UNOS Allocation System Change

We report the trends in utilization and outcomes of intra-aortic balloon pump (IABP) as a bridge to heart transplantation (HT) in the six-month period immediately before and after the implementation of the revised United Network of Organ Sharing (UNOS) allocation system in October 2018. The UNOS database was queried for HT candidates who required temporary mechanical circulatory support with IABP who were transplanted within a 6-month time window before (N=125) and after (N=193) the UNOS allocation change. Demographics, comorbidities, hemodynamics, and post-HT mortality were compared using standard statistical methods. Multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, ethnicity, ischemic time, dialysis, life support and HLA mismatch) was also performed for survival analysis. Mean age between the before and after groups, respectively, was similar (54.8 ± 12.0 vs. 54.2 ± 13.2 years, p=0.7). No significant differences were identified in recipient demographics, comorbidities, renal function or invasive hemodynamics at time of transplantation. There were no statistically significant differences in donor age or donor organ ischemic time. Total waitlist time was lower in the post-policy change group (median [inter-quartile range], 10.0 [5.0, 26.0] vs. 31.0 [11.0, 87.0] days; p<0.001). Additionally, there was no difference in post-HT mortality in the post-policy change group (5 vs. 4 deaths, p=0.16). The number of HT candidates on IABP at the time of HT has increased following implementation of the new UNOS allocation system with a concurrent reduction in candidate waitlist time, but no difference in post-HT mortality.

Is There a "Weekend Effect" in Multiorgan Transplantation?

Multiple organ transplant surgeries are complicated, prolonged, resource-heavy procedures which may be adversely affected by the timing of the surgery. We used the United Network of Organ Sharing (UNOS) Organ Registry to evaluate for a "Weekend Effect" on mortality, comparing multiorgan transplant surgeries that occurred on a weekday versus during the weekend. We conducted a retrospective cohort analysis of the UNOS Organ Registry for all multi-organ (i.e. heart and other organ(s)) transplants from 1987 to 2019, comparing mortality rates between weekday transplants (WDT) versus weekend transplants (WET). A multivariate Cox proportional hazard regression analysis was used adjusting for age, sex, diabetes, race, ischemic, time, need for dialysis and/or life support, wait time, and HLA mismatch. The exclusion criteria included age <10, patients lost to follow-up, and re-do heart transplants. Survival was censored at 10 years. 2,518 patients received multiorgan transplants on a weekday versus 804 patients during the weekend. Overall, the 10-year overall-mortality for WDT versus WET was 53.2% and 52.7% respectively, p=0.5120. Although there was a trend for higher non-cardiovascular death in the WDT group versus the WET group (79.7% versus 74.5%) and higher cardiovascular death in the WET group versus the WDT group (25.2% vs 20.3%) the difference did not meet statistical significance with a p=0.053. Based on this retrospective cohort analysis of the UNOS Organ Registry, there was no significant mortality "Weekend Effect" observed for multiorgan transplant surgeries.

Comparing Mortality in Heart Transplantation Utilizing Donor Hearts with and without CAD

We want to determine if there is a difference in outcomes in heart transplant (HTx) recipients who receive donor hearts with known coronary artery disease (CAD) versus those without CAD. Using the United Network of Organ Sharing (UNOS) Organ Registry, we compared mortality rates for HTx recipients who received donor hearts without CAD versus those with CAD with a multivariate Cox proportional hazard regression model adjusting for age, sex, race, diabetes diagnosis, ischemic time, need for dialysis/life support, recipient wait-time, and HLA mismatch. CAD was defined as 1 or more epicardial coronary vessels with ≥ 50% stenosis. We excluded patients who were age <10, lost-to-follow-up, multi-organ transplant and redo transplant recipients. We censored data at 10 years. There were a total of 45,236 unknown-CAD HTx recipients, 650 non-CAD HTx recipients and 79 CAD HTx recipients in the UNOS Organ Registry. Non-CAD HTx recipients were less likely to have had prior cardiac surgery (61.2% vs 77.2% respectively, p=0.005), more likely to receive a younger donor heart (45.0±8.4 years vs 48.0±6.9 years respectively, p=0.002), less likely to have a VAD at time of transplant (59.4% vs 78.5% respectively, p<0.001), and more likely to be listed at Status 1A (54.5% vs 45.6% respectively, p=0.002) or Status 1 (90.8% vs 74.4% respectively, p<0.001). The overall 10-year mortality is significantly lower in the non-CAD HTx recipients versus CAD HTx recipients (p=0.04). The vast majority of HTx recipients in the UNOS Organ Registry have donor hearts with unknown CAD status. Of those HTx recipients with known CAD, their 10-year mortality is significantly higher compared to non-CAD HTx recipients. This increased mortality may be in part due to donor CAD but is more likely multifactorial.

Heart Transplantation Mortality in Recipients with Muscular Dystrophy

We want to compare mortality in heart transplant (HTx) recipients with and without Muscular Dystrophy. Using the United Network of Organ Sharing (UNOS) Organ Registry we compared mortality rates for HTx recipients with a diagnosis of Muscular Dystrophy (MD), versus HTx recipients without a diagnosis of MD with a multivariate Cox proportional hazard regression model adjusting for age, sex, race, diabetes diagnosis, ischemic time, need for dialysis/life support, recipient wait-time, and HLA mismatch. MD was defined as Becker's Muscular Dystrophy, Emery-Dreifuss Muscular Dystrophy, Duchenne's Muscular Dystrophy, and Other Muscular Dystrophy. We excluded patients who were age <10, lost-to-follow-up, multi-organ transplant and redo transplant recipients. We censored data at 10 years. There were a total of 63,051 of non-MD HTx recipients versus 91 MD HTx patients. Non-MD HTx recipients were significantly older versus MD HTx recipients (46.7±19.2 years vs 27.5±14.3 years respectively, p<0.001), had a lower prevalence of diabetes (79.4% vs 97.8% respectively, p<0.001), were less likely to have had prior cardiac surgery (81.7% vs 94.5% respectively, p=0.002), had longer waitlist time (83.0 vs 61.0 days respectively, p =0.013), and were more likely to be a smoker (33.1% vs 11%, p,0.001). The mortality at 10 years was significantly higher for non-MD HTx recipients versus MD HTx recipients (45.9% vs 23.7% respectively, p = 0.0374). MD HTx patients have higher survival rates compared to NON-MD HTx patients, despite having a higher prevalence of diabetes and prior cardiac surgery.

Heart Transplant Outcomes for Patients with Cardiac Sarcoidosis

Cardiac sarcoidosis (CS) is a known etiology of both end-stage dilated and restrictive cardiomyopathy requiring heart transplantation. We sought to evaluate the long-term post-transplant outcomes of patients with CS compared to patients without CS. We evaluated the United Network of Organ Sharing (UNOS) registry for all heart transplant (HT) recipients from 1987 to 2019. Comparisons between patient characteristics of HT recipients with CS (N=288) and HT recipients without a diagnosis of CS (N=62,854) were reported using standard statistical methods including Cox proportional hazards regression for survival analysis. Sarcoid HT recipients were significantly older (52.4 ± 9.0 vs. 46.6 ± 19.2, p<0.001) and were more likely to be female (35.8% vs. 26.2%, p<0.001). Sarcoid HT recipients were also less likely to have diabetes (15.4% vs. 20.6%, p=0.03) and to have undergone prior cardiac surgery (12.2% vs. 18.3%, p=0.01). In terms of transplant related factors, sarcoid HT recipients were more likely to receive an older donor (32.1 ± 11.8 vs. 28.2 ± 14.0, p<0.001), but had similar ischemic times. Prior to transplant, the CS patients were less likely to require mechanical ventilation (0.3% vs. 4.3%, p=0.001), but had similar rate of ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO) requirements. Median time on the wait list was similar between both groups, however there was a lower overall post-transplant mortality in the sarcoid HT recipients (p<0.001). Cardiac sarcoidosis HT recipients tended to be an older population with less underlying co-morbidities such as diabetes and prior cardiac surgery. They were more likely to receive older donors. Although sarcoid HT recipients have similar organ wait times as non-CS recipients, they ultimately have a lower overall mortality.

IS THERE A “WEEKEND EFFECT” IN MULTIORGAN TRANSPLANTATION

Multiple organ transplant surgeries may be adversely affected by the timing of the surgery. We used the United Network of Organ Sharing (UNOS) Organ Registry to evaluate for a “Weekend Effect” on mortality, comparing multiorgan transplant surgeries that occurred on a weekday versus during the

Transplantation For Hcc: A National Analysis Of Recipient Selection Criteria

Presenter: Mackenzie Morris MD | University of Cincinnati Background: Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy with the Milan criteria being the standard to identify and prioritize patients for liver transplantation (LT). However, many centers in the United States are now performing LT in patients beyond Milan. In this study, we evaluated the outcomes of patients within and outside of Milan at LT as well as the impact of downstaging on outcomes after LT. Methods: The United Network of Organ Sharing (UNOS) database was queried for all patients with a diagnosis of HCC who underwent LT from 2009 to 2019. Pediatric patients and those without tumor-specific data were excluded. Patients were divided into three groups at LT: within Milan criteria (within Milan), within the University of California San Francisco (UCSF) criteria but beyond Milan (beyond Milan, within UCSF), and beyond both Milan and UCSF criteria (beyond UCSF) at the time of LT. Additionally, a subset analysis was performed for patients originally outside Milan, but within Milan or within UCSF at the time of LT. The cause of death variable was used to identify patients who died due to HCC in order to examine cause-specific survival. Results: A total of 16,883 patients (within Milan, n=16,165; beyond Milan, within UCSF, n=535; beyond UCSF, n=183) were identified who met inclusion criteria with a median follow-up of 2.9 (1.0-5.1) years. Kaplan-Meier survival analysis revealed a decreased overall and HCC cause-specific survival in patients within and beyond UCSF compared to those within Milan (p<0.01). In multivariate analysis of overall survival adjusting for recipient and donor specific factors, beyond Milan criteria, AFP > 90 mg/dL, and liver-directed therapy were associated with increased risk of death (Figure - black). In multivariate analysis for HCC cause-specific survival, beyond Milan criteria, AFP >90 mg/dL, and liver-directed therapy were associated with increased risk of death (Figure – grey). Finally, a subset analysis revealed no difference in overall survival in patients who were always within Milan (3-year survival of 82%) compared to those originally outside Milan but downstaged to within Milan (78%) or within UCSF at the time of LT (82%, p=0.44). Conclusion: UCSF criteria have been increasingly proposed to allow for expansion of patients who are able to undergo liver transplantation, but this expansion is not without risk of worse survival. However, patients who are down-staged to within UCSF may have similar Results to those always within Milan or those down-staged to within Milan.

Cardiac Transplantation Using Hearts With Transient Dysfunction: Role of Takotsubo-Like Phenotype

The impact of different types of regional wall motion abnormalities (RWMAs), including the Takotsubo syndrome-like (TTS-like) phenotype, on posttransplant outcomes when using donor hearts with transient left ventricular systolic dysfunction (LVSD) is unknown. We evaluated the prevalence, clinical characteristics, and prognostic association of different RWMAs including TTS-like hypokinesis and posttransplant outcomes when using donor hearts with transient LVSD. From all adult (≥18 years) heart transplants in United Network of Organ Sharing between January 2007 and September 2015, we identified 472 donor hearts with improving or transient LVSD, defined as left ventricular ejection fraction ≤ 40% on initial transthoracic echocardiogram (TTE) that improved to ≥50% on follow-up TTE during donor evaluation. These improved LVSD donors were then subdivided into 3 groups based on RWMAs on the initial TTE, TTS-like (49, 10.38%), non-TTS RWMAs (74, 15.68%), and diffuse global hypokinesis (349, 73.94%), and compared for baseline characteristics and posttransplant outcomes with follow up until June2018. Donors with TTS-like LVSD were older and more likely to be female. The type of RWMA on initial TTE (including TTS-like) of transient LVSD donor hearts was not associated with 1-year or 5-year posttransplant mortality. Posttransplant functional status scores of recipients (at 1 year) and donor left ventricular ejection fraction (at median follow-up of 3.6 years) improved in all 3 subgroups. Rates of stroke or pacemaker predischarge were also similar. In the largest analysis of transplanted donor hearts with transient LVSD, 1 in 4 had RWMAs on the initial TTE, but this was not associated with adverse posttransplant outcomes. Donor hearts with initial LVSD should be pursued irrespective of TTS-like hypokinesis or other RWMAs.

Improved Outcomes of Heart Transplantation in Adults With Congenital Heart Disease Receiving Regionalized Care

BackgroundThe number of adult congenital heart disease (CHD) patients undergoing heart transplantation is increasing rapidly. CHD patients have higher surgical risk at transplantation. High-volume adult CHD transplant centers may have better transplant outcomes. ObjectivesThis study aimed to evaluate the effect of center CHD transplant volume and expertise on transplant outcomes in CHD patients. MethodsThe authors studied heart transplantations in CHD patients age ≥18 years using the United Network of Organ Sharing (UNOS) database for the primary outcomes of waitlist mortality and post-transplant outcomes at 30 days and 1 year. Transplant centers were assessed by status as the highest CHD transplant volume center in a UNOS region versus all others, presence of Adult Congenital Heart Association accreditation, and adult versus pediatric hospital designation. ResultsBetween January of 2000 and June of 2018, 1,746 adult CHD patients were listed for transplant; 1,006 (57.6%) of these underwent heart transplantation. After adjusting for age, sex, listing status, and inotrope requirement, waitlist mortality risk was lower at Adult Congenital Heart Association accredited centers (hazard ratio: 0.730; p = 0.020). Post-transplant 30-day mortality was lower at the highest volume CHD transplant center in each UNOS region (hazard ratio: 0.706; p = 0.014). ConclusionsDesignated expertise in CHD care is associated with improved waitlist outcomes for CHD patients listed for transplantation. Post-transplant survival was improved at the highest volume regional center. These findings suggest a possible advantage of regionalization of CHD transplantation.

Ultra-short duration direct acting antiviral prophylaxis to prevent virus transmission from hepatitis C viremic donors to hepatitis C negative kidney transplant recipients.

We conducted an adaptive design single-center pilot trial between October 2017 and November 2018 to determine the safety and efficacy of ultra-short-term perioperative pangenotypic direct acting antiviral (DAA) prophylaxis for deceased hepatitis C virus (HCV)-nucleic acid test (NAT) positive donors to HCV negative kidney recipients (D+/R-). In Group 1, 10 patients received one dose of SOF/VEL (sofusbuvir/velpatasvir) pretransplant and one dose on posttransplant Day 1. In Group 2A (N=15) and the posttrial validation (Group 2B; N=25) phase, patients received two additional SOF/VEL doses (total 4) on Days 2 and 3 posttransplant. Development of posttransplant HCV transmission triggered 12-week DAA therapy. For available donor samples (N=27), median donor viral load was 1.37E+06IU/mL (genotype [GT]1a: 70%; GT2: 7%; GT3: 23%). Overall viral transmission rate was 12% (6/50; Group 1:30% [3/10]; Group 2A:13% [2/15]; Group 2B:4% [1/25]). For the 6 viremic patients, 5 (83%) achieved sustained virologic response (3 with first-line DAA therapy; and two after retreatment with second-line DAA). At a median follow-up of 8months posttransplant, overall patient and allograft survivals were 98%, respectively. The 4-day strategy reduced viral transmission to 7.5% (3/40; 95% confidence interval [CI]: 1.8%-20.5%) and could result in avoidance of prolonged posttransplant DAA therapy for most D+/R-transplants.

Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.

Solid organ transplant recipients are at risk for potentially life-threatening infections due to lifelong immunosuppression. Vaccine-preventable infections result in graft injury, morbidity, mortality, and significantly increased medical costs. Unfortunately, the majority of transplant recipients continue to be underimmunized at the time of transplant and thereafter. Given the rising rates of vaccine hesitancy and refusal in the general population, transplant recipients can no longer rely on herd immunity to protect them from vaccine-preventable infections. Novel tools are desperately needed to overcome transplant-specific immunization barriers to improve immunization rates in this high-risk population. Digital health technologies may offer a solution by addressing transplant-specific barriers: specifically, providing accurate information about vaccine safety, efficacy, and timing in the pre- and posttransplant periods; making a complete immunization record universally available and easily accessible; enabling communication between patients and multiple providers; and providing automated vaccine reminders to both patients and providers when vaccines are due using transplant-specific immunization guidelines. Digital health has transformed health care by empowering patients with their own health information and connecting patients, their providers, and public health officials. In doing so, it offers a potential platform to address and overcome the problem of underimmunization in the transplant population.

Marginal Improvement in Survival Post-Heart Transplantation in Patients With Prior Left Ventricular Assist Device: A Temporal Analysis of United Network of Organ Sharing Registry

An increasing number of patients undergoing heart transplantation are being bridged with left ventricular assist devices (LVADs). Bridge-to-transplantation (BTT) LVAD has improved wait list survival remarkably. Historically, post-heart transplantation survival in BTT-LVAD patients, however, has remained inferior to that of primary heart transplantation. The authors hypothesized that in the modern era, the difference between post-heart transplantation survival in BTT-LVAD versus primary heart transplantation should be reduced. The objective of the present study was to determine whether there has been a change in survival after heart transplantation in patients with prior LVAD. The present study's cohort was compared with a historical cohort using the United Network of Organ Sharing (UNOS) database from 1995 to 2004.5 DESIGN: Retrospective observational analysis of data from the United Network of Organ Sharing database. Registry-based, observational, retrospective. Patients undergoing adult orthotopic heart transplantation, excluding redo transplantation and multiorgan transplantations. None. From the UNOS database, 22,065 patients who underwent heart transplantation between January 1, 2006, and December 31, 2016, were analyzed. Of these, 7,008 (31.76%) patients had prior LVAD (BTT-LVAD). Data analysis was performed with R software (Version 3.5.1) for Kaplan-Meier survival analysis and Cox proportional hazard ratio (HR) modeling to identify variables influencing survival. For patients with prior LVAD, the overall HR was 1.15 (95% confidence interval [CI] 1.07-1.24) for survival. An HR of 3.22 (95% CI 2.23-4.68) for death in patients who received extracorporeal membrane oxygenation post-transplantation and an HR of 0.72 (95% CI 0.58-0.90) for survival in patients whose procedures were performed in high-volume centers performing more than 35 transplantations per year were identified. Reduced survival in patients who received an LVAD before heart transplantation persists. However, there may have been a slight improvement in the HR for survival in the study cohort in the recent decade compared with the historical cohort from previous decades. It is intriguing that despite the paramount advances in both technology and clinical practice of LVAD, relatively minor survival benefit, if any, has occurred in post-heart transplantation for patients bridged with prior LVAD.

Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices

BackgroundThe use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. Materials and methodsThe United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. ResultsA total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan–Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). ConclusionsRecipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.

103 Pancreatic Adenocarcinoma Following Liver Transplantation: UNOS Data Analysis

INTRODUCTION: Solid organ transplant recipients are at increased risk of de novomalignancies, in some cases up to 15.6%. Data regarding pancreatic cancer following liver transplantation is limited. We aim to evaluate the incidence of pancreatic adenocarcinoma among liver transplant recipients in the United States. Describe survival in those patients and identify subgroup of patients at increased risk. METHODS: We examined the United Network of Organ Sharing (UNOS) database and identified patients with pancreatic adenocarcinoma who underwent liver transplant between 1988 and 2016. Patients 18 years of age and older were included. Demographics, primary diagnosis and survival data were recorded. Kaplan-Meier survival analyses and log-rank tests were performed. RESULTS: In the UNOS database, survival data regarding 142,488 patients was available and the cause of death was identified in 14,533 liver transplant recipients. A total of 140 patients developed pancreatic adenocarcinoma after liver transplantation. Most common indications for transplantations were Hepatitis C, alcohol cirrhosis and hepatocellular carcinoma (25 [17.9%], 24 [17.1%] and 9 [6.4%] respectively). Annual incidence was 16 pancreatic cancer cases per 100,000 transplant recipients. Compared to national annual incidence of 12.9 cancer cases per 100,000 patients, the relative risk was 1.23 (95% CI 0.59–2.56). Compared to other liver transplant recipients, those who developed pancreatic cancer were older and transplanted earlier in the time period evaluated (P &lt; 0.001 and P = 0.002 respectively). Gender, ethnicity, BMI, and primary diagnosis (i.e., transplant indication) were not significantly different among groups. Patient survival was significantly lower in patients who developed pancreatic adenocarcinoma (Log-rank test P &lt; 0.001) (Figure 1). CONCLUSION: Analysis of the UNOS database showed that pancreatic adenocarcinoma is increased among liver transplant recipients without reaching statistical significance. Primary indications for transplantation and demographics were similar among both groups. Our findings suggest that pancreatic adenocarcinoma is more likely associated to long-standing immunosuppression and non-traditional risk factors rather than alcohol consumption or obesity. Further studies describing the natural history of pancreatic cancer after solid organ transplantation are suggested.

Heart Transplantation Survival and the Use of Traumatically Brain-Injured Donors: UNOS Registry Propensity-Matched Analysis.

BackgroundThe transplantation of hearts from traumatically brain‐injured (TBI) donors has been associated with inferior long‐term survival in single‐center analyses. However, in a more recent analysis, death caused by cerebrovascular accident was associated with worse posttransplant survival in recipients. The purpose of this study was to explore the outcomes of heart transplantation in recipients receiving donor hearts from TBI and non‐TBI donors in a large national registry.Methods and ResultsWe performed a retrospective cohort analysis of the UNOS (United Network of Organ Sharing) Registry Organ Procurement and Transplantation Network between 2006 and 2018 for adult candidates wait‐listed for isolated heart transplantation. Recipients were stratified into 2 groups, TBI and non‐TBI donors. Propensity score matching was performed. Kaplan‐Meier analysis was used to estimate survival posttransplant. A total of 24 894 candidates met inclusion criteria. TBI was the leading cause of death in the donor population. Recipients of TBI donor hearts (N=13 07) were younger (median age, 55 versus 57 years; P<0.001) and less likely women (21.6% versus 29.8%; P<0.001). At 10 years, the TBI group had better long‐term survival compared with the non‐TBI group (62.8% versus 59.9%; P<0.001). After propensity group matching, the 10‐year survival was similar between groups.ConclusionsIn the largest analysis of heart transplants and their survival, according to the type of donor injury (TBI versus non‐TBI), we found similar survival in heart transplant recipients. Future studies should address specific subpopulations (eg, hemorrhagic stroke) in the non‐TBI group to address concerns about reduced posttransplant survival.

The Safety and Efficacy Intra-Aortic Balloon Pump as a Bridge to Transplant Strategy under the New UNOS Allocation

Introduction We report the safety and efficacy of the IABP as a bridge to orthotopic heart transplantation (OHT) since the United Network of Organ Sharing (UNOS) instituted its updated organ allocation system on October 18th, 2018. Methods This is single-center retrospective analysis reporting the feasibility, safety, and efficacy of the use of IABP as a bridge to OHT. All patients in this study were admitted with cardiogenic shock to the heart failure ICU with an average cardiac index of 1.73±0.22 L/min/m2 and met criteria for hemodynamic support with IABP placement. Results The cohort consisted of 20 consecutive patients with IABP as a bridge to transplant (BTT). Mean age was 50 years old, 65% male, 60% non-ischemic, 20% ischemic, 10% congenital (CC-TGA), and 10% restrictive cardiomyopathy. The rate of successful axillary IABP insertion was 100%, with the majority from a percutaneous approach (15/16) and one via surgical graft. Of the original cohort, 17 patients were successfully bridged to OHT (axillary IABP n=14, femoral IABP n=3), 1 patient who did not have a contraindication to durable MCS received a BTT LVAD after 30 days of IABP support, and 2 patients required upgrade to higher levels of MCS support (Fig 1). All patients with axillary IABP placement ambulated with a physical therapist while awaiting OHT. There were no neurologic events, major bleeding, infections, or death. Balloon rupture necessitating urgent balloon replacement occurred in 15% of patients, and one patient with a femoral IABP required surgical thrombectomy of the common femoral artery. The mean total days with IABP before transplantation or LVAD was 12, with range of 2-30 days (Fig 2). Conclusion Since the recent change in the heart transplant allocation system, we report the largest series, to our knowledge, of patients being bridged to OHT with IABP, the majority of which are axillary. We demonstrate that IABP is a safe and effective platform of support for patients awaiting OHT, and furthermore, we demonstrate the feasibility of the axillary IABP approach.

Effect of Calculated Panel Reactive Antibody Value on Waitlist Outcomes for Lung Transplant Candidates.

BackgroundWe conducted a retrospective cohort study using United Network of Organ Sharing (UNOS) data to determine the effect of the calculated panel reactive antibody (cPRA) value on waitlist outcomes for lung transplant candidates.Material/MethodsWe divided lung transplant candidates into groups based on their cPRA value at the time of waitlist activation (0–25%, 25.1–50%, 50.1–75%, and 75.1–100%) and compared each group’s waitlist outcomes to the lowest quartile (“minimally sensitized”) group. The primary outcome was lung transplantation and the secondary outcome was waitlist mortality (a composite of death on the waitlist/delisting for clinical deterioration).ResultsCompared to the minimally sensitized group, candidates with a cPRA value of 25.1–50% did not have a significantly different likelihood of undergoing lung transplant or waitlist mortality, candidates with a cPRA value of 50.1–75% were 25% less likely to undergo lung transplant and 44% more likely to die on the waitlist, and candidates with a cPRA value of 75.1–100% were 52% less likely to undergo lung transplant and 92% more likely to die on the waitlist.ConclusionsCPRA values of greater than 50% are associated with significantly lower rates of transplantation and higher waitlist mortality.