{Reference Type}: Journal Article
{Title}: A comprehensive, multifaceted strategy to increase pediatric donor heart utilization.
{Author}: Hollander SA;Chen S;Dykes J;Kaufman BD;Lee E;Wujcik K;Profita E;Schmidt J;Rosenthal DN;
{Journal}: J Heart Lung Transplant
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 28
{Factor}: 13.569
{DOI}: 10.1016/j.healun.2024.06.015
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.