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

Yaron D. Barac, Oliver K. Jawitz, Jacob Klapper, Jacob Schroder, Mani A. Daneshmand, Chet Patel, Matt G. Hartwig, Nancy K Sweitzer, Carmelo A. Milano

Research output: Contribution to journalArticle

Abstract

Background The 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 Results We 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. Conclusions In 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.

Original languageEnglish (US)
Pages (from-to)e012894
JournalJournal of the American Heart Association
Volume8
Issue number17
DOIs
StatePublished - Sep 3 2019

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Heart Transplantation
Registries
Tissue Donors
Survival
Brain
Stroke
Propensity Score
Tissue and Organ Procurement
Kaplan-Meier Estimate
Organ Transplantation
Brain Injuries
Cause of Death
Cohort Studies
Transplants

Keywords

  • heart transplant
  • trauma brain injury
  • UNOS

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Heart Transplantation Survival and the Use of Traumatically Brain-Injured Donors : UNOS Registry Propensity-Matched Analysis. / Barac, Yaron D.; Jawitz, Oliver K.; Klapper, Jacob; Schroder, Jacob; Daneshmand, Mani A.; Patel, Chet; Hartwig, Matt G.; Sweitzer, Nancy K; Milano, Carmelo A.

In: Journal of the American Heart Association, Vol. 8, No. 17, 03.09.2019, p. e012894.

Research output: Contribution to journalArticle

Barac, Yaron D. ; Jawitz, Oliver K. ; Klapper, Jacob ; Schroder, Jacob ; Daneshmand, Mani A. ; Patel, Chet ; Hartwig, Matt G. ; Sweitzer, Nancy K ; Milano, Carmelo A. / Heart Transplantation Survival and the Use of Traumatically Brain-Injured Donors : UNOS Registry Propensity-Matched Analysis. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 17. pp. e012894.
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abstract = "Background The 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 Results We 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. Conclusions In 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.",
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T1 - Heart Transplantation Survival and the Use of Traumatically Brain-Injured Donors

T2 - UNOS Registry Propensity-Matched Analysis

AU - Barac, Yaron D.

AU - Jawitz, Oliver K.

AU - Klapper, Jacob

AU - Schroder, Jacob

AU - Daneshmand, Mani A.

AU - Patel, Chet

AU - Hartwig, Matt G.

AU - Sweitzer, Nancy K

AU - Milano, Carmelo A.

PY - 2019/9/3

Y1 - 2019/9/3

N2 - Background The 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 Results We 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. Conclusions In 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.

AB - Background The 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 Results We 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. Conclusions In 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.

KW - heart transplant

KW - trauma brain injury

KW - UNOS

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