Abstract：
BACKGROUND: In 2016, we initiated a quality improvement endeavor to increase pediatric heart offer acceptance. This study assessed the effect of these interventions at our center.
METHODS: We evaluted pre- and postimplementation cohorts (January 1, 2008-December 31, 2016 vs January 1, 2017-July 1, 2023) comparing donor heart utilization. Six interventions were iterated over time to increase offer acceptance (\"extended criteria\"): ABO-incompatible transplant, ex vivo perfusion for distanced donors, 3-dimensional total cardiac volume (TCV) assessment, acceptance of hepatitis-C or Severe Acute Respiratory Syndrome Coronavirus 2 infected donors, and institutional culture change favoring consideration of donors previously considered unacceptable. Outcomes studied included annual HT volume, median waitlist duration, sequence number at acceptance, and post-transplant clinical outcomes.
RESULTS: During the study period, annual transplant volume increased from 16/year to 25/year pre- and postimplementation. Three hundred thirteen of 389 (80%) listed patients were transplanted. Waitlist duration shortened postimplementation (p = 0.01), as did the percentage of accepted heart offers utilizing at least 1 extended criterion (p < 0.001). Institutional culture change and TCV assessment had the largest impact on donor heart utilization (p = 0.04 and p < 0.001). There was no difference in post-HT intubation or intensive care unit days (p = 0.05-0.9), though post-transplant hospitalization duration (p < 0.001) increased. Post-transplant survival was unaffected by the use of extended criteria hearts (p = 0.3).
CONCLUSIONS: We report a successful longitudinal, multifaceted effort to increase organ offer utilization, with institutional culture change and TCV assessments most impactful. The use of extended criteria hearts was not associated with inferior survival.
METHODS: We evaluted pre- and postimplementation cohorts (January 1, 2008-December 31, 2016 vs January 1, 2017-July 1, 2023) comparing donor heart utilization. Six interventions were iterated over time to increase offer acceptance (\"extended criteria\"): ABO-incompatible transplant, ex vivo perfusion for distanced donors, 3-dimensional total cardiac volume (TCV) assessment, acceptance of hepatitis-C or Severe Acute Respiratory Syndrome Coronavirus 2 infected donors, and institutional culture change favoring consideration of donors previously considered unacceptable. Outcomes studied included annual HT volume, median waitlist duration, sequence number at acceptance, and post-transplant clinical outcomes.
RESULTS: During the study period, annual transplant volume increased from 16/year to 25/year pre- and postimplementation. Three hundred thirteen of 389 (80%) listed patients were transplanted. Waitlist duration shortened postimplementation (p = 0.01), as did the percentage of accepted heart offers utilizing at least 1 extended criterion (p < 0.001). Institutional culture change and TCV assessment had the largest impact on donor heart utilization (p = 0.04 and p < 0.001). There was no difference in post-HT intubation or intensive care unit days (p = 0.05-0.9), though post-transplant hospitalization duration (p < 0.001) increased. Post-transplant survival was unaffected by the use of extended criteria hearts (p = 0.3).
CONCLUSIONS: We report a successful longitudinal, multifaceted effort to increase organ offer utilization, with institutional culture change and TCV assessments most impactful. The use of extended criteria hearts was not associated with inferior survival.
摘要：
背景：许多用于小儿心脏移植（HT）的心脏没有放置。2016年，我们发起了一项质量改进努力，以提高心脏报价接受度。这项研究评估了我们中心这些干预措施的效果。
方法：实施前/后队列评估（1/1/2008-12/31/2016vs.2017年1月1日-2023年7月1日）比较供体心脏利用率。随着时间的推移，对六种干预措施进行了迭代，以增加要约接受度(“扩展标准”)：ABO不相容移植，远距离供体的离体灌注，三维总心脏容积（TCV）评估，接受丙型肝炎或SARS-COV-2感染的供体，和有利于考虑以前认为不可接受的捐赠者的制度文化变革(公共卫生服务风险，心肺复苏持续时间长，等。).研究结果包括年度HT量，候补名单持续时间中位数，验收时的序列号，和移植后的临床结果。
结果：从1/2008-7/2023年开始，每年的移植量从16/年增加到25/年实施前/实施后。三百十三/389（80％）列出的患者进行了移植。实施后等待时间缩短(P=0.01)，使用至少一个扩展标准的接受心脏供血的百分比也是如此(P<0.001)。机构文化变化和TCV评估对供体心脏利用的影响最大（P=0.04和P<0.001）。在HT插管后或心血管重症监护病房(CVICU)天数上无差异(P=0.05-0.9),虽然移植后住院时间增加（P<0.001）。移植后的存活不受使用扩展标准心脏的影响（P=0.3）。
结论：我们报告了由于纵向，多方面的努力来提高器官的利用率，机构文化变革和TCV评估影响最大。使用延长标准心脏与低生存率无关。
方法：实施前/后队列评估（1/1/2008-12/31/2016vs.2017年1月1日-2023年7月1日）比较供体心脏利用率。随着时间的推移，对六种干预措施进行了迭代，以增加要约接受度(“扩展标准”)：ABO不相容移植，远距离供体的离体灌注，三维总心脏容积（TCV）评估，接受丙型肝炎或SARS-COV-2感染的供体，和有利于考虑以前认为不可接受的捐赠者的制度文化变革(公共卫生服务风险，心肺复苏持续时间长，等。).研究结果包括年度HT量，候补名单持续时间中位数，验收时的序列号，和移植后的临床结果。
结果：从1/2008-7/2023年开始，每年的移植量从16/年增加到25/年实施前/实施后。三百十三/389（80％）列出的患者进行了移植。实施后等待时间缩短(P=0.01)，使用至少一个扩展标准的接受心脏供血的百分比也是如此(P<0.001)。机构文化变化和TCV评估对供体心脏利用的影响最大（P=0.04和P<0.001）。在HT插管后或心血管重症监护病房(CVICU)天数上无差异(P=0.05-0.9),虽然移植后住院时间增加（P<0.001）。移植后的存活不受使用扩展标准心脏的影响（P=0.3）。
结论：我们报告了由于纵向，多方面的努力来提高器官的利用率，机构文化变革和TCV评估影响最大。使用延长标准心脏与低生存率无关。
