title: The Benefit of Donor-Recipient Matching for Patients Undergoing Heart Transplantation.
abstract: BACKGROUND
  Heart transplant volumes are not matching growing demand, and donor heart use may be decreasing.
  
  
  OBJECTIVE
  This study sought to investigate the benefit of heart transplantation compared with waiting while accounting for the estimated risk of a given donor-recipient match.
  
  
  METHODS
  This study identified 28,548 heart transplant candidates in the Organ Procurement and Transplant Network between July 2006 and December 2015. Donor-recipient match quality was estimated from the donor risk index. A time-dependent covariate Cox model was used to determine the effect of donor-recipient match quality on the likelihood of a composite outcome while waiting for a transplant or after transplantation. The composite outcome was death or delisting as too ill.
  
  
  RESULTS
  Donor and recipient risk estimates were inversely related to the candidate urgency. Net benefit from heart transplantation was evident across all estimates of donor-recipient status 1A and 1B candidates: status 1A (lowest-risk quartile hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.31 to 0.43; highest-risk quartile HR: 0.52; 95% CI: 0.44 to 0.61) and status 1B candidates (lowest-risk quartile HR: 0.41; 95% CI: 0.36 to 0.47; highest-risk quartile HR: 0.66; 95% CI: 0.58 to 0.74). Status 2 candidates showed a benefit from heart transplantation; however, survival benefit was delayed. For the highest-risk donor-recipient matches, a net benefit of transplantation occurred immediately for status 1A candidates, after 12 months for status 1B candidates, and after 3 years for status 2 candidates.
  
  
  CONCLUSIONS
  This study demonstrated a survival benefit of heart transplantation across all ranges of estimated donor-recipient match risk for status 1A and status 1B candidates. Donor heart acceptance should be the favored strategy for these candidates. The benefit of transplantation for status 2 candidates was less apparent and dependent on estimated donor-recipient match risk, suggesting that a measure of donor-recipient match quality may be useful when considering the immediate benefit of heart transplantation for status 2 candidates in stable condition.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: Vidang P
authors.initials: VP
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: Claudius
authors.initials: C
authors.lastname: Mahr
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Jay
authors.initials: J
authors.lastname: Pal
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington. Electronic address: tdardas@uw.edu.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Dardas
mesh_terms: D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: donor heart use; donor risk index; survival; urgency