Secular trends in cardiac transplant recipient and donor management in the United States, 1990 to 1994 - A multi-institutional study

Rodeheffer, R. J., Naftel, D. C., Ventura, H. O. and et al. (1996) Secular trends in cardiac transplant recipient and donor management in the United States, 1990 to 1994 - A multi-institutional study. Circulation, 94 11: 2883-2889.


Author Rodeheffer, R. J.
Naftel, D. C.
Ventura, H. O.
et al.
Title Secular trends in cardiac transplant recipient and donor management in the United States, 1990 to 1994 - A multi-institutional study
Journal name Circulation   Check publisher's open access policy
ISSN 0009-7322
Publication date 1996-12
Sub-type Article (original research)
Volume 94
Issue 11
Start page 2883
End page 2889
Total pages 7
Place of publication Baltimore, MD, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Background: The growth of the US cardiac transplant waiting list has outpaced the increase in donors, resulting in a widening gap between the number of waiting recipients and available donors. These trends have generated concern that longer waiting times may result in more patients deteriorating to urgent status and that transplanting only patients who are in an advanced state of decompensation will reduce posttransplant survival. Furthermore, the shortage of donors may result in extending the guidelines for donor acceptability to a degree that increases graft failure and posttransplant mortality. We measured these secular trends in the Cardiac Transplant Research Database to provide current data on time-dependent changes in US cardiac transplant practice and survival.

Methods and Results: At the time of this analysis, the Cardiac Transplant Research Database included all 2749 patients transplanted from January 1, 1990, to June 30, 1994, in the 25 participating transplant centers. During this 4.5-year period, the median waiting time for recipients who received a transplant increased from 2.7 to 3.5 months (P<.0001), and the proportion of recipients whose status was urgent at transplantation increased from 41% to 60% (P<.0001). Donor ischemic time increased from 150 to 166 minutes (P<.0001), and the proportion of donors requiring pressor support increased from 68% to 85% (P<.0001). Despite these changes in practice, the 1-year survival rate remained constant at 84% during this 4.5-year interval. There was no significant difference in 1-year survival rate between urgent status patients (83%) and nonurgent status patients (85%) (P=.08).

Conclusions: The widening gap between the number of waiting recipients and the number of donors has resulted in a continuing trend toward transplanting urgent status recipients and to a liberalization of donor acceptance criteria. Despite these changes, posttransplant survival has remained constant.
Keyword Transplantation
Survival
Heart failure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 10:14:14 EST