Life-years gained by reducing donor heart ischemic times.
BACKGROUND
Transplantation is limited by the number of available donor organs. Donor organ maintenance systems are a recent technological advance. These systems may increase the number of donor organs that can be used and improve outcomes by decreasing donor organ ischemic time (IT). The purpose of this study was to determine the potential life-years gained if IT in the United Kingdom were decreased for cardiac transplantation.


METHODS
Proportional hazards regression and extrapolation of survival rates beyond 20 years posttransplantation were used to estimate the effect of decreasing total IT on survival and the life-years gained over the lifetime of UK heart transplantation patients.


RESULTS
Median survival posttransplantation was 10.4 years (95% CI 9.9 to 10.9). For each additional hour of donor organ IT, patients had a 25% increased risk of death after heart transplantation in the first year after transplant, with a 5% increase thereafter (P<0.001). On average, a recipient surviving 10 years posttransplantation could potentially gain 0.4 (95% CI 0.1 to 0.7) life-years if IT was reduced to 1 hr. The longer the IT, the greater the potential life-years to gain; for example, a recipient of an organ that would have had an IT of 6 hr without the use of an organ maintenance system might expect to gain 2.9 life-years (95% CI -0.6 to 6.4) if IT was reduced to 1 hr.


CONCLUSIONS
Use of cardiac donor organ maintenance systems has the potential to increase posttransplantation survival.
Goldsmith
Kimberley A
KA
MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, United Kingdom.
Demiris
Nikolaos
N
Gooi
Julian H
JH
Sharples
Linda D
LD
Jenkins
David P
DP
Dhital
Kumud K
KK
Tsui
Steven S L
SS
D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D052096:Warm Ischemia / Q000401:mortality*; D055815:Young Adult