The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation

Todd C. Crawford, J. Trent Magruder, Joshua C. Grimm, Clinton D. Kemp, Alejandro Suarez-Pierre, Kenton J Zehr, Kaushik Mandal, Glenn Whitman, John V. Conte, Robert Higgins, Duke E. Cameron, Christopher M. Sciortino

Research output: Contribution to journalArticle

Abstract

Background: Concerns over prolonged allograft ischemia have limited the widespread adoption of long-distance organ procurement in heart transplantation (HT). We sought to assess whether donor distance from the center of transplantation independently affects mortality. Methods: We queried the United Network for Organ Sharing (UNOS) database for adults undergoing isolated HT from 2005 to 2012. Risk-adjusted Cox proportional hazards models were constructed for the primary outcomes of 30-day and 1-year mortality, and the independent impact of donor distance from transplantation center at the time of procurement was assessed. Results: We included 14,588 heart transplant recipients. The mean distance from location of the donor heart to transplantation center was 184.4 ± 214.6 miles; 1,214 HTs (8.3%) occurred at the same location as the donor heart. Ischemic times were inversely related to the distance from the site of donor procurement to recipient transplantation. After risk adjustment, longer donor distances (in miles) were associated with a significantly lower risk of mortality at both 30 days (hazard ratio [HR] 0.9993, 95% confidence interval [CI]: 0.9988 to 0.9998, p < 0.01) and 1 year (HR 0.9994, 95% CI: 0.9989 to 0.9999, p = 0.015). Risk-adjusted hazards for mortality were significantly reduced in recipients receiving hearts from more than 25 miles away. The hazard reduction was greatest in recipients receiving donor hearts from more than 500 miles away (1-year HR 0.64, p < 0.01; 30-day HR 0.47, p < 0.01). Conclusions: Longer distances between donor location and center of heart transplantation are associated with a reduced hazard for survival at 30 days and 1 year, despite greater ischemic times. Future studies are necessary to elucidate the protective factors surrounding long-distance heart donation.

LanguageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart Transplantation
Tissue Donors
Survival
Mortality
Transplantation
Confidence Intervals
Risk Adjustment
Tissue and Organ Procurement
Proportional Hazards Models
Allografts
Ischemia
Databases

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Crawford, T. C., Magruder, J. T., Grimm, J. C., Kemp, C. D., Suarez-Pierre, A., Zehr, K. J., ... Sciortino, C. M. (Accepted/In press). The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.01.055

The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation. / Crawford, Todd C.; Magruder, J. Trent; Grimm, Joshua C.; Kemp, Clinton D.; Suarez-Pierre, Alejandro; Zehr, Kenton J; Mandal, Kaushik; Whitman, Glenn; Conte, John V.; Higgins, Robert; Cameron, Duke E.; Sciortino, Christopher M.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Crawford, Todd C. ; Magruder, J. Trent ; Grimm, Joshua C. ; Kemp, Clinton D. ; Suarez-Pierre, Alejandro ; Zehr, Kenton J ; Mandal, Kaushik ; Whitman, Glenn ; Conte, John V. ; Higgins, Robert ; Cameron, Duke E. ; Sciortino, Christopher M. / The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation. In: Annals of Thoracic Surgery. 2017.
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abstract = "Background: Concerns over prolonged allograft ischemia have limited the widespread adoption of long-distance organ procurement in heart transplantation (HT). We sought to assess whether donor distance from the center of transplantation independently affects mortality. Methods: We queried the United Network for Organ Sharing (UNOS) database for adults undergoing isolated HT from 2005 to 2012. Risk-adjusted Cox proportional hazards models were constructed for the primary outcomes of 30-day and 1-year mortality, and the independent impact of donor distance from transplantation center at the time of procurement was assessed. Results: We included 14,588 heart transplant recipients. The mean distance from location of the donor heart to transplantation center was 184.4 ± 214.6 miles; 1,214 HTs (8.3{\%}) occurred at the same location as the donor heart. Ischemic times were inversely related to the distance from the site of donor procurement to recipient transplantation. After risk adjustment, longer donor distances (in miles) were associated with a significantly lower risk of mortality at both 30 days (hazard ratio [HR] 0.9993, 95{\%} confidence interval [CI]: 0.9988 to 0.9998, p < 0.01) and 1 year (HR 0.9994, 95{\%} CI: 0.9989 to 0.9999, p = 0.015). Risk-adjusted hazards for mortality were significantly reduced in recipients receiving hearts from more than 25 miles away. The hazard reduction was greatest in recipients receiving donor hearts from more than 500 miles away (1-year HR 0.64, p < 0.01; 30-day HR 0.47, p < 0.01). Conclusions: Longer distances between donor location and center of heart transplantation are associated with a reduced hazard for survival at 30 days and 1 year, despite greater ischemic times. Future studies are necessary to elucidate the protective factors surrounding long-distance heart donation.",
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AU - Crawford, Todd C.

AU - Magruder, J. Trent

AU - Grimm, Joshua C.

AU - Kemp, Clinton D.

AU - Suarez-Pierre, Alejandro

AU - Zehr, Kenton J

AU - Mandal, Kaushik

AU - Whitman, Glenn

AU - Conte, John V.

AU - Higgins, Robert

AU - Cameron, Duke E.

AU - Sciortino, Christopher M.

PY - 2017

Y1 - 2017

N2 - Background: Concerns over prolonged allograft ischemia have limited the widespread adoption of long-distance organ procurement in heart transplantation (HT). We sought to assess whether donor distance from the center of transplantation independently affects mortality. Methods: We queried the United Network for Organ Sharing (UNOS) database for adults undergoing isolated HT from 2005 to 2012. Risk-adjusted Cox proportional hazards models were constructed for the primary outcomes of 30-day and 1-year mortality, and the independent impact of donor distance from transplantation center at the time of procurement was assessed. Results: We included 14,588 heart transplant recipients. The mean distance from location of the donor heart to transplantation center was 184.4 ± 214.6 miles; 1,214 HTs (8.3%) occurred at the same location as the donor heart. Ischemic times were inversely related to the distance from the site of donor procurement to recipient transplantation. After risk adjustment, longer donor distances (in miles) were associated with a significantly lower risk of mortality at both 30 days (hazard ratio [HR] 0.9993, 95% confidence interval [CI]: 0.9988 to 0.9998, p < 0.01) and 1 year (HR 0.9994, 95% CI: 0.9989 to 0.9999, p = 0.015). Risk-adjusted hazards for mortality were significantly reduced in recipients receiving hearts from more than 25 miles away. The hazard reduction was greatest in recipients receiving donor hearts from more than 500 miles away (1-year HR 0.64, p < 0.01; 30-day HR 0.47, p < 0.01). Conclusions: Longer distances between donor location and center of heart transplantation are associated with a reduced hazard for survival at 30 days and 1 year, despite greater ischemic times. Future studies are necessary to elucidate the protective factors surrounding long-distance heart donation.

AB - Background: Concerns over prolonged allograft ischemia have limited the widespread adoption of long-distance organ procurement in heart transplantation (HT). We sought to assess whether donor distance from the center of transplantation independently affects mortality. Methods: We queried the United Network for Organ Sharing (UNOS) database for adults undergoing isolated HT from 2005 to 2012. Risk-adjusted Cox proportional hazards models were constructed for the primary outcomes of 30-day and 1-year mortality, and the independent impact of donor distance from transplantation center at the time of procurement was assessed. Results: We included 14,588 heart transplant recipients. The mean distance from location of the donor heart to transplantation center was 184.4 ± 214.6 miles; 1,214 HTs (8.3%) occurred at the same location as the donor heart. Ischemic times were inversely related to the distance from the site of donor procurement to recipient transplantation. After risk adjustment, longer donor distances (in miles) were associated with a significantly lower risk of mortality at both 30 days (hazard ratio [HR] 0.9993, 95% confidence interval [CI]: 0.9988 to 0.9998, p < 0.01) and 1 year (HR 0.9994, 95% CI: 0.9989 to 0.9999, p = 0.015). Risk-adjusted hazards for mortality were significantly reduced in recipients receiving hearts from more than 25 miles away. The hazard reduction was greatest in recipients receiving donor hearts from more than 500 miles away (1-year HR 0.64, p < 0.01; 30-day HR 0.47, p < 0.01). Conclusions: Longer distances between donor location and center of heart transplantation are associated with a reduced hazard for survival at 30 days and 1 year, despite greater ischemic times. Future studies are necessary to elucidate the protective factors surrounding long-distance heart donation.

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