4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting
OBJECTIVES/GOALS: We sought to examine: 1) variability in center acceptance patterns for heart allografts offered to the highest-priority candidates, 2) impact of this acceptance behavior on candidate survival, and 3) post-transplantation outcomes in candidates who accepted first rank offer vs. prev...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2020-06-01
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| Series: | Journal of Clinical and Translational Science |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2059866120003969/type/journal_article |
| _version_ | 1811155039832506368 |
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| author | Ashley Y Choi Michael S. Mulvihill Hui-Jie Lee Congwen Zhao Maragatha Kuchibhatla Jacob N. Schroder Chetan B. Patel Christopher B. Granger Matthew G. Hartwig |
| author_facet | Ashley Y Choi Michael S. Mulvihill Hui-Jie Lee Congwen Zhao Maragatha Kuchibhatla Jacob N. Schroder Chetan B. Patel Christopher B. Granger Matthew G. Hartwig |
| author_sort | Ashley Y Choi |
| collection | DOAJ |
| description | OBJECTIVES/GOALS: We sought to examine: 1) variability in center acceptance patterns for heart allografts offered to the highest-priority candidates, 2) impact of this acceptance behavior on candidate survival, and 3) post-transplantation outcomes in candidates who accepted first rank offer vs. previously declined offer. METHODS/STUDY POPULATION: In this retrospective cohort study, the US national transplant registry was queried for all match runs of adult candidates listed for isolated heart transplantation between 2007-2017. We examined center acceptance rates for heart allografts offered to the highest-priority candidates and accounted for covariates in multivariable logistic regression. Competing risks analysis was performed to assess the relationship between center acceptance rate and waitlist mortality. Post-transplantation outcomes (patient survival and graft failure) between candidates who accepted their first-rank offers vs those who accepted previously declined offers were compared using Fine-Gray subdistribution hazards model. RESULTS/ANTICIPATED RESULTS: Among 19,703 unique organ offers, 6,302 (32%) were accepted for first-ranked candidates. After adjustment for donor, recipient, and geographic covariates, transplant centers varied markedly in acceptance rates (12%-62%) of offers made to first-ranked candidates. Lowest acceptance rate centers (<25%) associated with highest cumulative incidence of waitlist mortality. For every 10% increase in adjusted center acceptance rate, waitlist mortality risk decreased by 27% (SHR 0.73, 95% CI 0.67-0.80). No significant difference was observed in 5-year adjusted post-Tx survival and graft failure between hearts accepted at the first-rank vs lower-rank positions. DISCUSSION/SIGNIFICANCE OF IMPACT: Wide variability in heart acceptance rates exists among centers, with candidates listed at low acceptance rate centers more likely to die waiting. Similar post-Tx survival suggests previously declined allografts function as well as those accepted at first offer. Center-level decision is a modifiable behavior associated with waitlist mortality. |
| first_indexed | 2024-04-10T04:27:26Z |
| format | Article |
| id | doaj.art-8a12b49521c3469e89e135c6c16fd40c |
| institution | Directory Open Access Journal |
| issn | 2059-8661 |
| language | English |
| last_indexed | 2024-04-10T04:27:26Z |
| publishDate | 2020-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Journal of Clinical and Translational Science |
| spelling | doaj.art-8a12b49521c3469e89e135c6c16fd40c2023-03-10T08:51:37ZengCambridge University PressJournal of Clinical and Translational Science2059-86612020-06-01413313410.1017/cts.2020.3964031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die WaitingAshley Y Choi0Michael S. Mulvihill1Hui-Jie Lee2Congwen Zhao3Maragatha Kuchibhatla4Jacob N. Schroder5Chetan B. Patel6Christopher B. Granger7Matthew G. Hartwig8Duke UniversityDuke University Medical CenterDepartment of Biostatistics, Duke UniversityDepartment of Biostatistics, Duke UniversityDepartment of Biostatistics, Duke UniversityDuke University Medical CenterDuke University Medical CenterDuke University Medical CenterDuke University Medical CenterOBJECTIVES/GOALS: We sought to examine: 1) variability in center acceptance patterns for heart allografts offered to the highest-priority candidates, 2) impact of this acceptance behavior on candidate survival, and 3) post-transplantation outcomes in candidates who accepted first rank offer vs. previously declined offer. METHODS/STUDY POPULATION: In this retrospective cohort study, the US national transplant registry was queried for all match runs of adult candidates listed for isolated heart transplantation between 2007-2017. We examined center acceptance rates for heart allografts offered to the highest-priority candidates and accounted for covariates in multivariable logistic regression. Competing risks analysis was performed to assess the relationship between center acceptance rate and waitlist mortality. Post-transplantation outcomes (patient survival and graft failure) between candidates who accepted their first-rank offers vs those who accepted previously declined offers were compared using Fine-Gray subdistribution hazards model. RESULTS/ANTICIPATED RESULTS: Among 19,703 unique organ offers, 6,302 (32%) were accepted for first-ranked candidates. After adjustment for donor, recipient, and geographic covariates, transplant centers varied markedly in acceptance rates (12%-62%) of offers made to first-ranked candidates. Lowest acceptance rate centers (<25%) associated with highest cumulative incidence of waitlist mortality. For every 10% increase in adjusted center acceptance rate, waitlist mortality risk decreased by 27% (SHR 0.73, 95% CI 0.67-0.80). No significant difference was observed in 5-year adjusted post-Tx survival and graft failure between hearts accepted at the first-rank vs lower-rank positions. DISCUSSION/SIGNIFICANCE OF IMPACT: Wide variability in heart acceptance rates exists among centers, with candidates listed at low acceptance rate centers more likely to die waiting. Similar post-Tx survival suggests previously declined allografts function as well as those accepted at first offer. Center-level decision is a modifiable behavior associated with waitlist mortality.https://www.cambridge.org/core/product/identifier/S2059866120003969/type/journal_article |
| spellingShingle | Ashley Y Choi Michael S. Mulvihill Hui-Jie Lee Congwen Zhao Maragatha Kuchibhatla Jacob N. Schroder Chetan B. Patel Christopher B. Granger Matthew G. Hartwig 4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting Journal of Clinical and Translational Science |
| title | 4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting |
| title_full | 4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting |
| title_fullStr | 4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting |
| title_full_unstemmed | 4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting |
| title_short | 4031 Heart Transplant Candidates Listed at Low First-Offer Organ Acceptance Rate Centers are More Likely to Die Waiting |
| title_sort | 4031 heart transplant candidates listed at low first offer organ acceptance rate centers are more likely to die waiting |
| url | https://www.cambridge.org/core/product/identifier/S2059866120003969/type/journal_article |
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