Abstract
Background:
This study evaluates the impact of donor age on outcomes following donation after circulatory death (DCD) heart transplantation.
Methods:
The UNOS registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation from 1/1/2019 to 9/30/2023. The cohort was stratified into two groups according to donor age, where advanced donor age was defined as ≥40 years. Outcomes were 90-day and 1-year post-transplant survival. Propensity score-matching was performed. Subgroup analysis was performed to evaluate the effects of recipient age on 90-day survival among the recipients with advanced age donors.
Results:
994 recipients were included in the study period, and 161 patients (17.1%) received allografts from advanced age donors. During the study period, the annual incidence of DCD heart transplantation with advanced age donors substantially increased. The recipients with advanced age donors had similar 90-day and 1-year post-transplant survival compared to the recipients with younger donors. The comparable 90-day survival persisted in a propensity score-matched comparison. In the sub-group analysis among the recipients with advanced age donors, the recipients ≥60 years old had significantly reduced 90-day survival compared to the recipients <60 years old.
Conclusions:
The use of appropriately selected DCD donors ≥40 years old has similar survival compared to that of younger donors. With careful candidate risk stratification and selection, consideration of using DCD donors over the age of 40 may further ameliorate ongoing organ shortage with comparable early post-transplant outcomes.
Keywords: orthotopic heart transplantation, donation after circulatory death, donor age, adverse events, survival
Introduction
Heart transplantation continues to be the gold standard therapy for patients with end-stage heart failure refractory to medical therapy.1 With the rising number of patients with heart failure, the discrepancy between the supply and demand for available donor hearts persists.2 In response to this challenge, there has been a growing interest in expanding the donor pool by utilizing hearts donated after circulatory death (DCD).3 Several studies have evaluated the safety and efficacy of heart transplantation using DCD donors. The results from these studies have collectively demonstrated comparable early post-transplant outcomes between DCD and donation after brain death (DBD) heart transplant recipients, suggesting a promising avenue to address the pressing demand for transplantable hearts.4–6
During the initial adoption of DCD heart transplantation, many centers limited their donor age limit to <40 years.5 This limitation primarily stemmed from concerns that older hearts may not withstand prolonged ischemic times and may also harbor atherosclerotic coronary artery disease, leading to inferior outcomes.7 With continuous advancements in procurement techniques and strategies to preserve and assess donor hearts, centers around the world are progressively expanding their DCD donor acceptance criteria to include older donors and longer warm ischemic times.6 Despite the growing adoption of DCD heart transplantation, there remains a paucity of literature assessing the impact of the broadened donor criteria on post-transplant morbidity and mortality. This study utilized a national registry database to evaluate the effects of donor age on outcomes following isolated DCD heart transplantation in the United States.
Materials and Methods
Data source
The United Network for Organ Sharing (UNOS) registry database was utilized for this study. Patient and medical center identifiers were excluded from the analysis. This study was approved by the institutional review board at the University of Pittsburgh Medical Center (MOD18120143-003, approved 3/9/2020). Due to the retrospective nature of the study, the need for informed consent for the study was waived.
Study Population
This study included all adult recipients (age ≥18 years) who underwent isolated DCD heart transplantation between 1/1/2019 and 9/30/2023 with a 90-day follow-up extending to 12/31/2023. Multi-visceral, heterotopic, and DBD heart transplant recipients were excluded. The cohort was stratified into two groups according to donor age, where advanced donor age was defined as ≥40 years old. Recipients with missing or unknown transplant data were excluded.
Baseline Characteristics and Outcomes
Recipient, donor, and transplant characteristics and outcomes data were collected from the UNOS registry database and were compared between the two groups. Primary outcomes were 90-day and 1-year post-transplant survival. Secondary outcomes included hospital length of stay and rates of post-transplant renal failure requiring dialysis, stroke, permanent pacemaker insertion, and acute rejection requiring medical therapy. Furthermore, a propensity score-matched comparison was made between the two cohorts of patients with similar baseline characteristics.
Sub-group analysis was performed to evaluate the effects of recipient age on 90-day post-transplant survival among the recipients with advanced age DCD donors. Lastly, the 90-day post-transplant survival was compared between DBD and DCD recipients, stratified by donor age. For this analysis, isolated DBD heart transplant recipients during the same study period were included and dichotomized according to donor age, where advanced donor age was defined as ≥40 years old.
Data Analysis
Baseline characteristics, including demographic and clinical data, are presented as frequency (percentage) for categorical variables and mean (± standard deviation) or median [interquartile range] for continuous variables. Pearson’s Chi-square test or Fisher’s exact test were utilized for categorical comparisons. Student’s t-test was employed for normally distributed continuous variables, and Wilcoxon rank-sum test was utilized for non-normally distributed continuous variables. Kaplan-Meier survival analysis with the associated log-rank test was utilized to compare overall post-transplant survival.
Propensity score-matching was performed to match two groups of patients with similar baseline recipient, donor, and transplant characteristics. Matching was done on a 1:1 basis using nearest neighbor matching without replacement and caliper setting of 0.2 of the standard deviation of the logit propensity score. A standardized mean difference of <15% was considered adequately matched, and an SMD of <10% was considered well-matched.
Multivariable Cox regression was performed to determine the risk-adjusted impact of advanced donor age on 90-day post-transplant mortality. In this model, the impact of advanced donor age was adjusted for established risk factors for post-transplant mortality among heart transplant recipients.8 Patients with missing data were removed from multivariable modeling.
Restricted cubic spline based on logistic regression was used to flexibly model the association between the donor age and the likelihood of 90-day post-transplant mortality. The donor age was modeled with 5 knots, and the reference donor age was set to 30 years. This model was adjusted with established risk factors for post-transplant mortality among heart transplant recipients.8 The statistical analyses were performed using Stata (StataCorp, College Station, TX) version 17 statistical software.
Results
Baseline Characteristics
A total of 994 recipients were included and analyzed in this study (Figure 1A). Of these, 161 patients (17.1%) received hearts from advanced age DCD donors. During the study period, the annual incidence of isolated DCD heart transplantation with advanced age donors increased to 38 cases (12.5%) in 2022 from 0 cases in 2019 (Figure 1B).
Figure 1.
A) Flow chart for post-transplant recipient selection and inclusion/exclusion criteria in this study. B) Annual number of isolated heart transplantations from donation after circulatory death stratified by donor age.
The recipients with advanced age donors had a higher proportion of status 6 and a lower rate of durable left ventricular assist device implantation. The advanced age donors had a lower proportion of Black race, elevated body mass index, and higher rates of diabetes mellitus and hypertension. In the advanced donor age group, the recipients were more likely to receive cytomegalovirus-matched grafts with shorter distances between donor and recipient hospitals and total graft preservation times. Otherwise, the two groups had comparable baseline characteristics (Table 1).
Table 1.
Baseline characteristics stratified by donor age in unmatched cohort.
| <40 years (n=833) |
≥40 years (n=161) |
P-value | |
|---|---|---|---|
| Recipient characteristics | |||
| Age (years) | 57 [44-64] | 57 [49-65] | 0.11 |
| Female sex | 177 (21.2%) | 26 (16.1%) | 0.14 |
| Race | 0.26 | ||
| White | 562 (67.5%) | 120 (74.5%) | |
| Black | 173 (20.8%) | 22 (13.7%) | |
| Hispanic | 79 (9.5%) | 16 (9.9%) | |
| Asian | 14 (1.7%) | 3 (1.9%) | |
| Other | 4 (0.5%) | 0 (0.0%) | |
| Body mass index (kg/m2) | 28.5 ± 5.0 | 28.8 ± 4.6 | 0.58 |
| Recipient blood type | 0.49 | ||
| A | 291 (34.9%) | 56 (34.8%) | |
| AB | 27 (3.2%) | 3 (1.9%) | |
| B | 97 (11.6%) | 14 (8.7%) | |
| O | 418 (50.2%) | 88 (54.7%) | |
| Heart failure etiology | 0.099 | ||
| Non-Ischemic | 435 (52.2%) | 72 (44.7%) | |
| Ischemic | 229 (27.5%) | 53 (32.9%) | |
| Congenital | 27 (3.2%) | 7 (4.3%) | |
| Restrictive | 37 (4.4%) | 7 (4.3%) | |
| Valvular | 13 (1.6%) | 4 (2.5%) | |
| Hypertrophic | 36 (4.3%) | 4 (2.5%) | |
| Other | 16 (1.9%) | 0 (0.0%) | |
| Education level | 0.37 | ||
| High school | 297 (36.6%) | 65 (41.7%) | |
| College | 430 (53.0%) | 79 (50.6%) | |
| Graduate degree | 84 (10.4%) | 12 (7.7%) | |
| Diabetes mellitus | 255 (30.6%) | 37 (23.0%) | 0.052 |
| Cerebrovascular accident | 56 (6.7%) | 11 (6.8%) | 0.96 |
| Prior cardiac surgery | 359 (43.1%) | 73 (45.3%) | 0.60 |
| Pretransplant dialysis | 9 (1.1%) | 2 (1.2%) | 0.86 |
| Total bilirubin (mg/dL) | 0.87 ± 0.77 | 0.85 ± 0.60 | 0.67 |
| Serum creatinine (mg/dL) | 1.21 ± 0.47 | 1.26 ± 0.49 | 0.30 |
| Pretransplant mechanical ventilation | 4 (0.5%) | 0 (0.0%) | 0.38 |
| Intensive care unit at time of transplant | 276 (33.1%) | 43 (26.7%) | 0.11 |
| Intravenous inotropes | 253 (30.4%) | 43 (26.7%) | 0.35 |
| Intra-aortic balloon pump | 129 (15.5%) | 16 (9.9%) | 0.068 |
| Extracorporeal membrane oxygenation | 13 (1.6%) | 1 (0.6%) | 0.35 |
| Impella | 18 (2.2%) | 3 (1.9%) | 0.81 |
| Durable ventricular assist device | 228 (27.4%) | 29 (18.0%) | 0.013 |
| Cardiac index (L/min/m2) | 2.13 ± 0.59 | 2.07 ± 0.61 | 0.22 |
| Donor Characteristics | |||
| Age (years) | 28 [23-33] | 43 [41-45] | <0.001 |
| Female | 125 (15.0%) | 18 (11.2%) | 0.21 |
| Race | <0.001 | ||
| White | 647 (77.7%) | 121 (75.2%) | |
| Black | 85 (10.2%) | 10 (6.2%) | |
| Hispanic | 88 (10.6%) | 22 (13.7%) | |
| Asian | 4 (0.5%) | 7 (4.3%) | |
| Other | 9 (1.1%) | 1 (0.6%) | |
| Body mass index (kg/m2) | 27.5 ± 6.6 | 28.8 ± 5.7 | 0.017 |
| Blood type | 0.20 | ||
| A | 252 (30.3%) | 46 (28.6%) | |
| AB | 2 (0.2%) | 0 (0.0%) | |
| B | 73 (8.8%) | 7 (4.3%) | |
| O | 506 (60.7%) | 108 (67.1%) | |
| Mechanism of death | <0.001 | ||
| Trauma | 378 (45.4%) | 50 (31.1%) | |
| Cerebrovascular | 59 (7.1%) | 26 (16.1%) | |
| Drug overdose | 193 (23.2%) | 37 (23.0%) | |
| Other | 203 (24.4%) | 48 (29.8%) | |
| Cocaine use | 215 (27.7%) | 46 (33.3%) | 0.18 |
| Diabetes mellitus | 15 (1.8%) | 9 (5.7%) | 0.004 |
| Hypertension | 245 (29.4%) | 69 (42.9%) | <0.001 |
| Serum creatinine (mg/dL) | 1.12 ± 1.40 | 1.28 ± 2.03 | 0.24 |
| Graft left ventricular ejection fraction <50% | 10 (1.2%) | 1 (0.6%) | 0.52 |
| Positive Cytomegalovirus serology | 465 (56.6%) | 81 (51.3%) | 0.21 |
| Hepatitis C | 67 (8.0%) | 19 (11.8%) | 0.12 |
| Matching and Transplant Characteristics | |||
| Sex matched | 703 (84.4%) | 139 (86.3%) | 0.53 |
| Race matched | 485 (58.2%) | 96 (59.6%) | 0.74 |
| Human leukocyte antigen matched (≤3 loci mismatch) | 93 (11.2%) | 15 (9.3%) | 0.49 |
| ABO matched | 723 (86.8%) | 138 (85.7%) | 0.71 |
| Cytomegalovirus matched | 401 (48.8%) | 95 (60.1%) | 0.009 |
| Waitlist time (days) | 33 [9-182] | 37 [11-200] | 0.49 |
| Donor distance to transplanting center (nautical miles) | 340 [136-566] | 237 [51-524] | 0.005 |
| Graft preservation time (hours) | 5.0 [3.5-6.5] | 4.4 [2.7-6.2] | 0.040 |
| Redo transplantation | 17 (2.0%) | 0 (0.0%) | 0.067 |
| Status at time of transplantation | 0.008 | ||
| 1 | 22 (2.6%) | 0 (0.0%) | |
| 2 | 288 (34.6%) | 51 (31.7%) | |
| 3 | 148 (17.8%) | 22 (13.7%) | |
| 4 | 254 (30.5%) | 52 (32.3%) | |
| 5 | 1 (0.1%) | 2 (1.2%) | |
| 6 | 120 (14.4%) | 34 (21.1%) |
Impact of Donor Age on Post-transplant Outcomes
In an unmatched comparison, the recipients with advanced age donors had similar 30-day (95.4% vs 97.0%) and 90-day (94.5% vs 94.3%) post-transplant survival compared to the recipients with younger donors (p=0.948, Figure 2A). The comparable 90-day survival with advanced age donors persisted after adjusting for established risk factors for post-transplant mortality among heart transplant recipients (HR 0.95; 95% CI 0.43-2.13, p=0.904) (Table 2).8 The two groups had similar hospital lengths of stay and rates of post-transplant dialysis, stroke, permanent pacemaker insertion, and acute rejection requiring medical therapy (Table 3).
Figure 2.
A) Kaplan-Meier estimates for A) 90-day and B) 1-year post-transplant survival stratified by donor age in unmatched cohort. C) Adjusted restricted cubic splines demonstrating the odds ratio for 90-day post-transplant mortality. The red line represents reference donor age of 30 years. The blue line represents predicted odds ratio, and the shaded area represents 95% confidence interval.
Table 2.
Multivariable Cox regression model for 90-day mortality following donation after circulatory death heart transplantation.
| Hazard Ratio | 95% Confidence Interval | P-Value | |
|---|---|---|---|
| Donor age | |||
| <40 years old | Ref | Ref | Ref |
| ≥40 years old | 0.95 | 0.43, 2.13 | 0.904 |
| Recipient age, increasing, per year | 1.03 | 1.01, 1.06 | 0.034 |
| Diabetes mellitus | 1.02 | 0.56, 1.86 | 0.945 |
| Prior cardiac surgery | 2.38 | 1.32, 4.30 | 0.004 |
| Total bilirubin, increasing, per 1 mg/dL | 1.21 | 0.98, 1.48 | 0.071 |
| Serum creatinine, increasing, per 1 mg/dL | 1.38 | 0.82, 2.32 | 0.228 |
| Total graft preservation time, increasing, per hour | 1.14 | 1.01, 1.29 | 0.033 |
9 (0.9%) study patients were excluded from the final model due to incomplete data.
Table 3.
Post-transplant outcomes stratified by donor age in unmatched cohort.
| <40 years (n=833) |
≥40 years (n=161) |
P-value | |
|---|---|---|---|
| Dialysis | 154 (18.5%) | 29 (18.1%) | 0.91 |
| Stroke | 34 (4.1%) | 9 (5.6%) | 0.39 |
| Permanent pacemaker | 10 (1.2%) | 3 (1.9%) | 0.50 |
| Hospital length of stay (days) | 16 [12-26] | 16 [12-24] | 0.28 |
| Treated acute rejection | 78 (9.4%) | 14 (8.7%) | 0.79 |
For the evaluation of 1-year survival, the study period was confined to 1/1/2019 through 12/31/2022 with a 1-year follow-up extending to 12/31/2023. The recipients with advanced age donors had equivalent 180-day (93.7% vs 95.2%) and 1-year (91.8% vs 92.9%) post-transplant survival compared to the recipients with younger donors (p=0.719, Figure 2B).
A restricted cubic spline analysis was performed to flexibly model the association between the donor age and the odds of 90-day post-transplant mortality. This model was adjusted for established predictors of post-transplant mortality, including recipient race, recipient age, body mass index, heart failure etiology, diabetes mellitus, prior cardiac surgery, pretransplant total bilirubin, pretransplant serum creatinine, bridge to transplant with extracorporeal membrane oxygenation, pretransplant blood transfusion, pretransplant mechanical ventilation, and total graft ischemia time.8 The spline model demonstrated similar odds of 90-day post-transplant mortality with increasing donor age compared to the reference age of 30 years (Figure 2C).
Propensity Score-Matched Comparisons
Propensity score-matching resulted in 280 patients, with 140 patients with donor age <40 years and 140 patients with donor age ≥40 years. Both groups were adequately matched with respect to baseline recipient, donor, and transplant-related characteristics except for recipient Asian race, restrictive heart failure etiology, and donor cytomegalovirus serology (Table E1). The two groups continued to have comparable 30-day (96.4% vs 97.0%) and 90-day (95.4% vs 95.3%) post-transplant survival (p=0.965, Figure 3). Furthermore, the two groups had similar hospital lengths of stay and rates of post-transplant dialysis, stroke, permanent pacemaker insertion, and acute rejection requiring medical therapy (Table E2).
Figure 3.
Kaplan-Meier estimates for post-transplant survival stratified donor age in propensity score-matched cohort. The shaded area represents 95% confidence interva
Effects of Recipient Age and Donor Type
To evaluate the effects of recipient age, the advanced age donor cohort was further stratified into recipient age <60 years (n=87) and ≥60 years (n=74) sub-groups. Kaplan-Meier survival estimates demonstrated that the recipients ≥60 years old had significantly reduced 90-day survival (90.3% vs 98.4%, p=0.045) compared to the recipients <60 years old (Figure 4A).
Figure 4.
Kaplan-Meier estimates for 90-day survival stratified by A) recipient age among the recipients with advanced age donors and B) donor type and donor age. The shaded area represents 95% confidence interva
To assess the impact of donor type, isolated DBD heart transplant recipients (n=13,344) during the same study period were included, where 3,477 recipients (26.1%) received hearts from advanced age DBD donors (donor age ≥40 years). In an unmatched comparison, the recipients with advanced age DCD donors had similar 90-day post-transplant survival compared to the recipients with younger DCD, younger DBD, and advanced age DBD donors (94.5% vs 94.3% vs 95.3% vs 94.2%, respectively) (p=0.061, Figure 4B). The comparable 90-day survival among the groups persisted after adjusting for established risk factors for post-transplant mortality among heart transplant recipients (Table E3).8
Discussion
This study, utilizing the UNOS registry database, evaluated the effects of donor age on outcomes following isolated DCD heart transplantation. The key findings include: 1) the incidence of DCD heart transplants involving donors over the age of 40 years is increasing, 2) donor age greater than 40 years does not adversely affect early post-transplant outcomes, 3) advanced age DCD and DBD donors have comparable early post-transplant survival, and 4) the impact of advanced age DCD donors is influenced by recipient age (Figure 5).
Figure 5.
Summary of the study design and key findings. DCD, Donation after circulatory death. The shaded area represents 95% confidence interva
The scarcity of available donor hearts has led to a significant increase in the number of patients on the waitlist.9 This challenge is further exacerbated by the selective use of donor hearts based on the quality, which is largely determined by age, ventricular function, preservation time, and comorbidities. In the United States, many centers routinely reject offers from donors above the age of 45 years and 40 years for DBD and DCD heart transplantation, respectively.1,10 Despite this conservative practice, the median age of donors continues to climb, driven by factors like the overall aging population and the growing prevalence of heart failure patients.10,11 Our study aligns with this evolving pattern. In 2022, donors over the age of 40 years were utilized in nearly 13% of all isolated DCD heart transplantation in the United States, representing more than a 3-fold increase compared to 2020. As the disparity between supply and demand escalates, the relevance of considering extended criteria donors will become even more pronounced, highlighting the need for adaptability in addressing the current challenges in organ transplantation.
With the advent of innovative organ preservation systems coupled with enhanced clinical expertise utilizing DCD donors, many transplant centers have broadened their acceptance criteria for DCD donors to include those aged <55 years. However, the utilization of older donors in DCD heart transplantation remains a topic of discussion due to the uncertainties surrounding their outcomes.4 Several studies in DBD heart transplantation have indicated an association between older donor age and increased post-transplant mortality and morbidities.12–15 Although adjusting for other predictors of post-transplant outcomes has tempered the severity of these effects, the consensus recommends careful risk stratification and selection of candidates when using advanced age donors.1,15,16 In our study, we observed that utilizing hearts from donors aged ≥40 years resulted in comparable early post-transplant outcomes to those from donors aged <40 years. However, when accounting for recipient age, the recipients aged ≥60 years exhibited significantly lower 90-day survival than the recipients aged <60 years when receiving hearts from advanced age donors. Therefore, older donors may be deemed acceptable for younger recipients with comparable outcomes, but caution is advised in selecting older donors for older recipients, as they appear to compromise early post-transplant survival. Additional studies are necessary to explore the dynamic interplay between the age of donors and recipients and its consequential effects on post-transplant outcomes. Moreover, it’s important to recognize that the study’s limited sample size only provided sufficient statistical power to detect a 15-20% difference in survival. Therefore, as the heart transplantation community gains additional experience with DCD donors, it is imperative to conduct long-term reassessments with larger sample sizes to accurately evaluate the impact of advanced age donors.
In our study, the recipients with advanced age DCD and DBD donors exhibited similar early post-transplant survival. This finding suggests that DCD and DBD heart transplantation result in similar outcomes regardless of age, further augmenting the notion that DCD donor hearts do not negatively impact post-transplant outcomes.17 Although the present study highlights the positive effects of DCD donor utilization and supports the expansion of DCD heart transplantation, it’s important to note in our analysis that more than 60% of the advanced age donor hearts were allocated to recipients with lower transplant statuses, predominantly status 4. Emerging evidence suggests that the benefits of DCD hearts are disproportionately distributed among the transplant statues.3 This may be due to the tendency of the transplant centers to accept DCD offers for their lower-tier candidates, such as statuses 4 to 6, who may not be competitive for quality DBD offers. As the clinical experience and literature on DCD heart transplantation evolve, a more thorough examination of the utilization and allocation patterns of DCD hearts among different status categories and optimal donor selection criteria will become increasingly more relevant.
Study Limitations
There are several limitations to this study. Firstly, its retrospective and non-randomized nature introduces inherent biases. Similar to other multicenter databases, the UNOS registry is prone to inaccurate data entry and missing data. There is limited granular information on the recipient, donor, and transplant-related characteristics. These include practice patterns, postoperative management strategies, surgeon and institutional preferences, bridging modalities, and recipient/donor selection criteria. In this study, it’s important to consider that the use of advanced age DCD donors was a relative contraindication. Consequently, the discriminatory, incongruous candidate and donor selection may have contributed to the heterogeneity within the advanced donor age cohort, potentially leading to selection bias and impacting the study results.
The UNOS registry database does not provide information on the rates of primary graft dysfunction and post-transplant mechanical circulatory support, which would have been valuable to assess. The study only included and analyzed adult recipients who underwent isolated DCD heart transplantation leading to selection bias, limiting the generalizability of findings to pediatric populations, multi-organ transplantation, and DBD heart transplantation. The heterogeneity of the DCD donor acceptance criteria among the transplant centers may have impacted the study results. Lastly, our results are susceptible to type II statistical error due to the relatively smaller sample size.
Conclusion
The present study of 994 adult isolated DCD heart transplant recipients demonstrates the incidence of DCD heart transplantations with advanced age donors is increasing in the United States. Furthermore, the use of appropriately selected DCD donors over the age of 40 years has similar early post-transplant survival compared to that of younger donors. With careful candidate risk stratification and selection, consideration of using DCD donors over the age of 40 years may further help ameliorate ongoing organ shortage with comparable early post-transplant outcomes.
Supplementary Material
Central Message:
The use of appropriately selected DCD donors over the age of 40 yields similar early post-transplant survival and complications compared to younger donors.
Perspective Statement:
The discrepancy between the supply and demand for available donor hearts persists. Donation after circulatory death (DCD) represents a promising avenue to ameliorate the ongoing organ shortage. With the aging population, the median donor age is rising. Therefore, understanding the effects of advanced age donors is critical to improve the outcomes in patients undergoing DCD heart transplantation.
Funding:
Dr. Yeahwa Hong is supported by the National Heart, Lung, and Blood Institute (T32HL160526) and the Thoracic Surgery Foundation Resident Research Fellowship.
Abbreviations:
- CI
confidence interval
- DBD
donation after brain death
- DCD
donation after circulatory death
- HR
hazard ratio
- UNOS
United Network for Organ Sharing
Footnotes
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Disclosure Statement: Dr. Kaczorowski received consultant and speaking fees for Medtronic and Abiomed. There are no direct conflicts of interest as it relates to this manuscript.
Meeting: Oral presentation at the 104th American Association for Thoracic Surgery Annual Meeting
Institutional Review Board Approval: This study was approved by the Institutional Review Board at the University of Pittsburgh (MOD18120143-003, approved 3/9/2020).
Disclaimer/Data Availability Statement
The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.