SECULAR TRENDS IN CARDIAC TRANSPLANT RECIPIENT AND DONOR MANAGEMENT IN THE UNITED-STATES, 1990 TO 1994 - A MULTIINSTITUTIONAL STUDY

Background The growth of the US cardiac transplant waiting list has ou tpaced the increase in donor, resulting in a widening gap between the number of waiting recipients and available donors. These trends have g enerated concern that longer waiting times may result in more patients deteriorating to urgent status and that transplanting only patients w ho are in an advanced state of decompensation will reduce posttranspla nt survival. Furthermore, the shortage of donors may result in extendi ng the guide lines for donor acceptability to a degree that increases graft failure and posttransplant mortality. We measured these secular trends in the Cardiac Transplant Research Database to provide current data on time-dependent changes in US cardiac transplant practice and s urvival. Methods and Results At the time of this analysis, the Cardiac Transplant Research Database included all 2749 patients transplanted from January 1, 1990, to June 30, 1994, in the 25 participating transp lant centers. During this 4.5-year period, the median waiting time for recipients who received a transplant increased from 2.7 to 3.5 months (P<.0001), and the proportion of recipients whose status was urgent a t transplantation increased from 41% to 60% (P<.0001). Donor ischemic time increased from 150 to 166 minutes (P<.0001), and the proportion o f donors requiring presser support increased from 68% to 85% (P<.0001) . Despite these changes in practice, the 1-year survival rate remained constant at 84% during this 4.5-year interval. There was no significa nt difference in 1-year survival rate between urgent status patients ( 83%) and nonurgent status patients (85%) (P=.08). Conclusions The wide ning gap between the number of waiting recipients and the number of do nors has resulted in a continuing trend toward transplanting urgent st atus recipients and to a liberalization of donor acceptance criteria. Despite these changes, posttransplant survival has remained constant.