Sabina P. W. Guenther, René Schramm, Jeffrey J. Teuteberg, Yasuhiro Shudo, Anna L. Rogge, Katharina E. Schaeper, Henrik Fox, Lisa Hoepner, Chawannuch Ruaengsri, Angelika Costard-Jaeckle, William Hiesinger, Y. Joseph Woo, Michiel Morshuis, Kiran K. Khush, Jan F. Gummert, Brian J. Wayda
{"title":"Which Donor and Recipient Risk Factors Matter in Heart Transplantation? Results From a Survey of 53 Centers Across Five Countries","authors":"Sabina P. W. Guenther, René Schramm, Jeffrey J. Teuteberg, Yasuhiro Shudo, Anna L. Rogge, Katharina E. Schaeper, Henrik Fox, Lisa Hoepner, Chawannuch Ruaengsri, Angelika Costard-Jaeckle, William Hiesinger, Y. Joseph Woo, Michiel Morshuis, Kiran K. Khush, Jan F. Gummert, Brian J. Wayda","doi":"10.1111/ctr.70214","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Consensus regarding what defines acceptable heart transplant (HT) donors or recipients is lacking. This survey analyzed how risk factors guide donor and recipient selection, and how practices vary across systems.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>An online survey was conducted among adult HT centers in the US and Eurotransplant (ET) region. We aimed to represent at least 50% of the total adult HT volumes in both regions. Centers were stratified by their HT volumes. To compensate for non-responders, a safety margin was included, and centers accounting for at least 75% of the total HT volumes were contacted. Centers were queried on relative thresholds and absolute cutoffs for continuous risk factors. For other factors, their influence on donor heart acceptance or the likelihood of listing recipients was assessed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Fifty-three centers from five countries participated: 39 US (accounting for 51.0% of the US HT volume), and 14 ET centers (65.0%) from four countries. ET centers more liberally considered advanced age donor hearts (threshold 64.5 [60.0–70.0] vs. 50.0 [50.0–55.0] years, <i>p</i> < 0.001), and hearts with abnormal echocardiography or coronary findings. Diabetes, smoking, and hypertension were rated by a quarter to more than half of US and ET centers as moderately or heavily influencing donor heart acceptance. ET centers more liberally listed candidates with chronic kidney disease (GFR 30.0 [21.5–32.5] vs. 35.0 [30.0–40.0] mL/min/1.73m<sup>2</sup>, <i>p</i> < 0.001). US centers, conversely, allowed for higher candidate ages (71.5 [70.0–74.0] vs. 68.0 [65.0–70.0] years, <i>p</i> < 0.001), and more likely (76.9%) listed candidates on ECMO support (42.9% of ET centers to less likely list, <i>p</i> = 0.022).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Selection practices differed distinctly between the US and ET. Further, practices appear to be driven by caution and are more conservative than current guidelines. Strengthening the evidence base to objectify and optimize donor and candidate selection could help alleviate the unmet need for donor hearts.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70214","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Consensus regarding what defines acceptable heart transplant (HT) donors or recipients is lacking. This survey analyzed how risk factors guide donor and recipient selection, and how practices vary across systems.
Methods
An online survey was conducted among adult HT centers in the US and Eurotransplant (ET) region. We aimed to represent at least 50% of the total adult HT volumes in both regions. Centers were stratified by their HT volumes. To compensate for non-responders, a safety margin was included, and centers accounting for at least 75% of the total HT volumes were contacted. Centers were queried on relative thresholds and absolute cutoffs for continuous risk factors. For other factors, their influence on donor heart acceptance or the likelihood of listing recipients was assessed.
Results
Fifty-three centers from five countries participated: 39 US (accounting for 51.0% of the US HT volume), and 14 ET centers (65.0%) from four countries. ET centers more liberally considered advanced age donor hearts (threshold 64.5 [60.0–70.0] vs. 50.0 [50.0–55.0] years, p < 0.001), and hearts with abnormal echocardiography or coronary findings. Diabetes, smoking, and hypertension were rated by a quarter to more than half of US and ET centers as moderately or heavily influencing donor heart acceptance. ET centers more liberally listed candidates with chronic kidney disease (GFR 30.0 [21.5–32.5] vs. 35.0 [30.0–40.0] mL/min/1.73m2, p < 0.001). US centers, conversely, allowed for higher candidate ages (71.5 [70.0–74.0] vs. 68.0 [65.0–70.0] years, p < 0.001), and more likely (76.9%) listed candidates on ECMO support (42.9% of ET centers to less likely list, p = 0.022).
Conclusion
Selection practices differed distinctly between the US and ET. Further, practices appear to be driven by caution and are more conservative than current guidelines. Strengthening the evidence base to objectify and optimize donor and candidate selection could help alleviate the unmet need for donor hearts.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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