Effect of the UNOS policy change on rates of rejection, infection, and hospital readmission following heart transplantation.

Autor:	Vaidya AS; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California. Electronic address: Ajay.vaidya@med.usc.edu., Lee ES; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California., Kawaguchi ES; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California., DePasquale EC; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California., Pandya KA; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California., Fong MW; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California., Nattiv J; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California., Villalon S; Keck Medical Center of University of Southern California, Los Angeles, California., Sertic A; Keck Medical Center of University of Southern California, Los Angeles, California., Cochran A; Keck Medical Center of University of Southern California, Los Angeles, California., Ackerman MA; Keck Medical Center of University of Southern California, Los Angeles, California., Melendrez M; Keck Medical Center of University of Southern California, Los Angeles, California., Cartus R; Keck Medical Center of University of Southern California, Los Angeles, California., Johnston KA; Keck Medical Center of University of Southern California, Los Angeles, California., Lee R; Keck Medical Center of University of Southern California, Los Angeles, California., Wolfson AM; Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2023 Oct; Vol. 42 (10), pp. 1415-1424. Date of Electronic Publication: 2023 May 20.
DOI:	10.1016/j.healun.2023.05.008
Abstrakt:	Background: The 2018 adult heart allocation policy sought to improve waitlist risk stratification, reduce waitlist mortality, and increase organ access. This system prioritized patients at greatest risk for waitlist mortality, especially individuals requiring temporary mechanical circulatory support (tMCS). Posttransplant complications are significantly higher in patients on tMCS before transplantation, and early posttransplant complications impact long-term mortality. We sought to determine if policy change affected early posttransplant complication rates of rejection, infection, and hospitalization. Methods: We included all adult, heart-only, single-organ heart transplant recipients from the UNOS registry with pre-policy (PRE) individuals transplanted between November 1, 2016, and October 31, 2017, and post-policy (POST) between November 1, 2018, and October 31, 2019. We used a multivariable logistic regression analysis to assess the effect of policy change on posttransplant rejection, infection, and hospitalization. Two COVID-19 eras (2019-2020, 2020-2021) were included in our analysis. Results: The majority of baseline characteristics were comparable between PRE and POST era recipients. The odds of treated rejection (p = 0.8), hospitalization (p = 0.69), and hospitalization due to rejection (p = 0.76) and infection (p = 0.66) were similar between PRE and POST eras; there was a trend towards reduced odds of rejection (p = 0.08). In both COVID eras, there was a clear reduction in rejection and treated rejection with no effect on hospitalization for rejection or infection. Odds of all-cause hospitalization was increased in both COVID eras. Conclusions: The UNOS policy change improves access to heart transplantation for higher acuity patients without increasing early posttransplant rates of treated rejection or hospitalization for rejection or infection, factors which portend risk for long-term posttransplant mortality. (Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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