(307) Preserved Post-Transplant Survival in Patients Receiving Hard to Place Organs (HTPO): A Unos Database Analysis

PurposeDonor hearts are allocated to recipients according to pre-specified criteria. HTPO are defined as those that were transplanted after more than 50 centers declined the offer. Transplant centers may decline organs due to multiple characteristics (i.e. size, quality of the allograft). The objective of this study was to evaluate the clinical and epidemiological characteristics and post-transplant outcomes of patients who received HTPO.MethodsAdult patients listed for heart transplant (HT) between October 18, 2018 and December 7, 2021 and underwent transplantation in the new allocation system were included in the study. Clinical and epidemiological characteristics of the donor and recipient at time of transplant were compared between groups. Post-transplant survival was compared between organs accepted within 50 offers and HTPO.ResultsA total of 2084 patients received HT. Of these, 1891 (90.7%) patients received hearts that were accepted within 50 offers and 193 (9.3%) patients received HTPO. Recipients of HTPO were more likely to be female (45% vs 24% p<0.001), less likely to require life support (ECMO/IABP), less likely to be on IV inotropes, had better hemodynamics, were listed at a lower status, and had longer times on the waitlist (354 vs 242 days p<0.001). There was more distance between the donor center and the transplant center and longer ischemic times (3.2 vs 3.6 hrs p<0.001) in HTPO. Donors of HTPO were older (38 vs 32 yrs p<0.001) and more often female (58% vs 27% p<0.001). The one year post-transplant survival was similar between the group of patients that received a heart within 50 offers and the group that received a HTPO (93% vs 96%, p = 0.092).ConclusionIn the new heart transplant allocation system, patients who received hard to place organs (HTPO) had similar post-transplant survival compared to those who received hearts in <50 offers. This preserved survival occurred in spite of older donors and longer ischemic times. Donor hearts are allocated to recipients according to pre-specified criteria. HTPO are defined as those that were transplanted after more than 50 centers declined the offer. Transplant centers may decline organs due to multiple characteristics (i.e. size, quality of the allograft). The objective of this study was to evaluate the clinical and epidemiological characteristics and post-transplant outcomes of patients who received HTPO. Adult patients listed for heart transplant (HT) between October 18, 2018 and December 7, 2021 and underwent transplantation in the new allocation system were included in the study. Clinical and epidemiological characteristics of the donor and recipient at time of transplant were compared between groups. Post-transplant survival was compared between organs accepted within 50 offers and HTPO. A total of 2084 patients received HT. Of these, 1891 (90.7%) patients received hearts that were accepted within 50 offers and 193 (9.3%) patients received HTPO. Recipients of HTPO were more likely to be female (45% vs 24% p<0.001), less likely to require life support (ECMO/IABP), less likely to be on IV inotropes, had better hemodynamics, were listed at a lower status, and had longer times on the waitlist (354 vs 242 days p<0.001). There was more distance between the donor center and the transplant center and longer ischemic times (3.2 vs 3.6 hrs p<0.001) in HTPO. Donors of HTPO were older (38 vs 32 yrs p<0.001) and more often female (58% vs 27% p<0.001). The one year post-transplant survival was similar between the group of patients that received a heart within 50 offers and the group that received a HTPO (93% vs 96%, p = 0.092). In the new heart transplant allocation system, patients who received hard to place organs (HTPO) had similar post-transplant survival compared to those who received hearts in <50 offers. This preserved survival occurred in spite of older donors and longer ischemic times.