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The revised United Network for Organ Sharing heart allocation policy was Implemented In October 2018. Using a national transplant database, this study evaluated the transplant rate, waitlist mortality, waiting time, and other outcomes of en-bloc heart-lung transplantation recipients. Adult patients registered on the national database for heart- lung transplants before and after the policy update were selected as cohorts. Baseline characteristics, transplant rates, waitlist mortality, waiting times, and other outcomes were compared between the two periods. In total, 370 patients were registered for heart-lung transplants during the pre- and post-periods. There were significantly higher transplant rates, shorter waitlist times, and substantially reduced waitlist mortality in the post-period. Registered patients waitlisted in the post-period had significantly higher utilization of intra-aortic balloon pumps, extracorporeal membrane oxygenation, and overall life support, including ventricular assist devices. Transplant recipients had significantly longer ischemic times, increased transport distances, and shorter waiting times before transplantation in the post-policy period. Transplant recipients held similar short-term survival before and after the policy change (log-rank test, p = 0.4357). Therefore, the revised policy significantly improved access to en-bloc heart-lung allografts compared with the prior policy, with better waitlist outcomes and similar post-transplant outcomes. [ABSTRACT FROM AUTHOR]

Summary: White kidney transplant candidates have the highest pre‐transplant mortality rate compared to other ethnicities. The reason for a higher mortality rate is not well‐understood. Estimated post‐transplant survival (EPTS) score has been used to predict patient survival after transplant and may be associated with pre‐transplant survival. First‐time kidney transplant candidates listed between 2015 and 2018 were identified from the Organ Procurement Transplantation Network database. Individuals listed for multiple organs, at multiple centers, and age <18 years were excluded. We examined the impact of ethnicity on waitlist mortality and delisting. A total of 114 806 candidates were included. The study population was categorized into four groups which were 43% white, 28% Black, 19.2% Hispanic, and 9.8% "other ethnicities." At 5.2 years, the cumulative incidences of death and delist were 32%, 31%, 29%, and 26%, respectively. Compared to whites, adjusted subdistribution hazard ratio (aSHR) for death and delist among Black, Hispanics, and "other ethnicities" were 0.92 (95% CI 0.89–0.95), 0.89 (95% CI 0.85–0.91), and 0.76 (95% CI 0.72–0.80) after adjustment by EPTS along with other factors, respectively. After adjusting for EPTS score along with additional confounding factors and functional status at initial listing, white ethnicity was independently associated with an increased risk for death and delist. [ABSTRACT FROM AUTHOR]

Summary: Benefit of direct‐acting antivirals (DAA) for hepatitis C virus (HCV) on clinical outcomes is unclear. We examined temporal trends in liver transplant (LT) listings, receipt of LT, re‐LT, and survival between pre‐DAA (2009–2012) and DAA era (2013–2016) using UNOS database. Of 32 319 first adult LT, 15 049 (47%) were performed for HCV. Trends on listing, first LT, and of re‐LT for HCV showed 23%, 20%, and 21% decrease in DAA compared to pre‐DAA era (P < 0.0001). One‐year liver graft and patient survival among HCV LT improved in DAA era (90% vs. 86% and 92% vs. 88%, respectively, P < 0.0001). Non‐HCV LT showed no improvement in survival (89% vs. 89% and 92% vs. 92.4%, P = NS). On cox regression, compared to non‐HCV LTs in DAA era, LT for HCV in pre‐DAA era had worse patient survival (HR 1.56 [1.04–2.35]). The outcome was similar when compared to LTs for HCV in DAA era and for non‐HCV in pre‐DAA era. Burden of HCV‐related LT waitlist and LT is declining in DAA era, with improved post‐transplant outcomes, more so in later than earlier DAA era. Our findings negate recent Cochrane meta‐analysis on DAA therapy and encourage studies to examine HCV clinical outcomes outside LT setting. [ABSTRACT FROM AUTHOR]

Intestinal transplantation ( ITX) can be a successful treatment for patients with irreversible intestinal failure and associated severe complications. Because of long waiting periods and organ shortages, the precise identification of eligible patients and their early referral to centers that perform ITX is important. We retrospectively analyzed all patients who were referred to our center between 2000 and 2011 concerning their referral criteria, waitlist characteristics, and outcome. A total of 87 patients (47 male patients, 40 female patients; median age 39.8 ± 13.4 years) were referred to our center. All patients presented with intestinal failure caused by short bowel syndrome or motility disorders. About 80.5% of patients were evaluated for isolated ITX, modified multivisceral ( mMVTX), or multivisceral transplantation ( MVTX). About 56.3% were listed at EUROTRANSPLANT, 33.3% suffered from severe secondary organ failure requiring MVTX, and 34.5% were transplanted. 14.3% (all MVTX-candidates) died on the waitlist as a result of infectious complications. The high proportion of MVTX candidates underlines the need for early referral to specialized centers. MVTX-candidates have a high waitlist mortality for different reasons. However, the current allocation policy for MVTX does not mirror the severity of disease and may therefore contribute to high waitlist mortality. [ABSTRACT FROM AUTHOR]