Utilization of high donor sequence number grafts in cardiac transplantation |
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Authors: | John J Squiers J Michael DiMaio Giovanna Saracino Huanying Qin Joost Felius Themistokles Chamogeorgakis Juan C MacHannaford Aldo E Rafael Parag Kale Susan M Joseph Shelley A Hall Gonzalo V Gonzalez‐Stawinski Brian Lima |
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Institution: | 1. Baylor Scott & White Research Institute, Dallas, TX, USA;2. Department of Surgery, Baylor University Medical Center, Dallas, TX, USA;3. Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA;4. Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA |
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Abstract: | Donor sequence number (DSN) represents the number of candidates to whom a graft was offered and declined prior to acceptance for transplantation. We sought to investigate the outcomes of patients receiving high DSN grafts. Consecutive isolated adult cardiac transplantations performed at a single‐center were reviewed. Recipients were grouped into standard (≤75th percentile) DSN and high (>75th percentile) DSN. A previously validated donor risk index was used to quantify the risk associated with donor grafts, and recipient outcomes were assessed. Overall, 254 patients were included: 194 standard DSN (range 1‐79) and 60 high DSN (range 82‐1723). High DSN grafts were harvested at greater distance (P < .001) with increased ischemia time (P < .001), resulting in a modest increase in donor risk index (1 point median difference, P = .014). High DSN recipients were less frequently listed as UNOS status 1A (P < .001). Despite a nonsignificant trend toward increased in‐hospital/30‐day mortality in high DSN recipients, there were no differences in primary graft dysfunction or 1‐year survival (high DSN 89% vs standard DSN 88%, P = .82). After adjustment for risk factors, high DSN was not associated with increased 1‐year mortality (hazard ratio 1.18, 95%‐CI 0.54‐2.58, P = .68). |
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Keywords: | donors and donation extended criteria organ acceptance organ allocation organ procurement |
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