Impact of Extended Heart Recovery Distance on Transplant Outcome Under the Current Heart Allocation Policy.

Abstract

Whereas the current allocation policy prioritizes donor hearts within a 500-mile radius for high-priority candidates, aligning with a benchmark of 4-hour ischemia time, limited data exist on the outcomes of heart transplant using brain-dead donor hearts recovered from extended distances (EDs). We hypothesized that ED heart procurement yields comparable outcomes to standard distances (<500 miles), driven by advances in organ preservation and perioperative care. From October 18, 2018, to March 31, 2023, 11,704 isolated heart transplants using brain-dead donors were identified and compared between those sourced from standard distances within 500 miles (control; n = 10,324) and ED donors beyond 500 miles (n = 1380). Propensity score matching was performed (1380 pairs). Before matching, ED recipients were older (58 vs 56 years; P < .001), and had lower rates of pretransplant mechanical circulatory support. Donors in the ED group were older (33 vs 32 years; P < .001) and more likely to be female (37% vs 28%; P < .001). The rate of machine perfusion use was higher in the ED group (9.6% vs 1.5%; P < .001). Ischemia time was longer (4.4 vs 3.3 hours; P < .001) in the ED group. Median follow-up was 2.04 years. One-year survival (93.1% vs 92.1%; P = .34) and freedom from graft figure (92.8% vs 91.5%; P = .26) were similar. In a multivariable Cox model, recovery distance was not associated with mortality (hazard ratio, 0.89; 95% CI, 0.73-1.08; P = .23). Despite longer ischemia times, heart transplants using brain-dead donors from ED were safe and demonstrated comparable survival to those procured within 500 miles under the current allocation policy.