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Published: 26 July 2024

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1

HIMMA, KENNETH EINAR. "A Critique of UNOS Liver Allocation Policy." Cambridge Quarterly of Healthcare Ethics 8, no. 3 (July 1999): 311–20. http://dx.doi.org/10.1017/s0963180199803065.

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The United Network for Organ Sharing (UNOS) recently changed the policy by which donor livers are allocated to liver failure patients in the United States. Formerly, all liver failure patients were characterized as status 1 and placed at the top of the transplant list. Under the new policy, only patients with liver failure due to acute illness (“ALF patients”) are eligible for status 1; patients with liver failure due to chronic liver disease (“CLF patients”) are characterized as status 2. Since donor organs are allocated first to status 1 patients and then to status 2 patients, the new policy moves all CLF patients down on the waiting list relative to all ALF patients. This means that some livers that would have gone to CLF patients under the old policy will now go to ALF patients. Accordingly, while the new policy will likely increase the number of ALF patients saved, it will also increase the number of deaths among CLF patients waiting for a transplant.

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ANKENY, RACHEL A. "Recasting the Debate on Multiple Listing for Transplantation through Consideration of Both Principles and Practice." Cambridge Quarterly of Healthcare Ethics 8, no. 3 (July 1999): 330–39. http://dx.doi.org/10.1017/s0963180199803089.

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Debates continue to surround the system in the United States for allocating transplantable cadaveric organs, due in large part to the scarcity of such organs in relation to the number of individuals waiting to undergo transplantation. Candidates awaiting transplantation gain access to cadaveric organs by being placed by individual transplant programs on the national list of the Organ Procurement and Transplantation Network (OPTN), overseen by the United Network for Organ Sharing (UNOS). In recent years, the UNOS board has visited (and revisited) the issue of multiple listing, that is, allowing one candidate to be registered on the waiting lists of two or more transplant programs, and has continued to permit multiple listing.

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3

Timofte, Irina, Marniker Wijesinha, Roumen Vesselinov, June Kim, Robert Reed, Pablo G. Sanchez, Nicholas Ladikos, et al. "Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD." ERJ Open Research 6, no. 2 (April 2020): 00177–2019. http://dx.doi.org/10.1183/23120541.00177-2019.

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BackgroundCOPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established.MethodsWe identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility criteria and data completeness, 1337 UNOS and 596 NETT patients remained. Kaplan–Meier estimates of transplant-free survival from transplantation for UNOS, and NETT randomisation, were compared between propensity score-matched UNOS (n=401) and NETT (n=262) patients.ResultsIn propensity-matched analyses, transplanted patients had better survival compared to medically managed patients in NETT (p=0.003). Stratifying on 6 min walk distance (6 MWD) and FEV1, UNOS patients with 6 MWD <1000 ft (∼300 m) or FEV1 <20% of predicted had better survival than NETT counterparts (median survival 5.0 years UNOS versus 3.4 years NETT; log-rank p<0.0001), while UNOS patients with 6 MWD ≥1000 ft (∼300 m) and FEV1 ≥20% had similar survival to NETT counterparts (median survival, 5.4 years UNOS versus 4.9 years NETT; log-rank p=0.73), interaction p=0.01.ConclusionsOverall survival is better for matched lung transplant patients compared with medical management alone. Patients who derive maximum benefit are those with 6 MWD <1000 ft (∼300 m) or FEV1 <20% of predicted, compared with pulmonary rehabilitation and medical management.

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4

Cho, Sylvia, Margaret Sin, Demetra Tsapepas, Leigh-Anne Dale, Syed A. Husain, Sumit Mohan, and Karthik Natarajan. "Content Coverage Evaluation of the OMOP Vocabulary on the Transplant Domain Focusing on Concepts Relevant for Kidney Transplant Outcomes Analysis." Applied Clinical Informatics 11, no. 04 (August 2020): 650–58. http://dx.doi.org/10.1055/s-0040-1716528.

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Abstract Background Improving outcomes of transplant recipients within and across transplant centers is important with the increasing number of organ transplantations being performed. The current practice is to analyze the outcomes based on patient level data submitted to the United Network for Organ Sharing (UNOS). Augmenting the UNOS data with other sources such as the electronic health record will enrich the outcomes analysis, for which a common data model (CDM) can be a helpful tool for transforming heterogeneous source data into a uniform format. Objectives In this study, we evaluated the feasibility of representing concepts from the UNOS transplant registry forms with the Observational Medical Outcomes Partnership (OMOP) CDM vocabulary to understand the content coverage of OMOP vocabulary on transplant-specific concepts. Methods Two annotators manually mapped a total of 3,571 unique concepts extracted from the UNOS registry forms to concepts in the OMOP vocabulary. Concept mappings were evaluated by (1) examining the agreement among the initial two annotators and (2) investigating the number of UNOS concepts not mapped to a concept in the OMOP vocabulary and then classifying them. A subset of mappings was validated by clinicians. Results There was a substantial agreement between annotators with a kappa score of 0.71. We found that 55.5% of UNOS concepts could not be represented with OMOP standard concepts. The majority of unmapped UNOS concepts were categorized into transplant, measurement, condition, and procedure concepts. Conclusion We identified categories of unmapped concepts and found that some transplant-specific concepts do not exist in the OMOP vocabulary. We suggest that adding these missing concepts to OMOP would facilitate further research in the transplant domain.

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5

Papalexopoulos, Theodore, James Alcorn, Dimitris Bertsimas, Rebecca Goff, Darren Stewart, and Nikolaos Trichakis. "Applying Analytics to Design Lung Transplant Allocation Policy." INFORMS Journal on Applied Analytics 53, no. 5 (September 2023): 350–58. http://dx.doi.org/10.1287/inte.2023.0036.

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In 2019, the United Network for Sharing (UNOS), which has been operating the Organ Procurement and Transplantation Network (OPTN) in the United States since 1984, was seeking to design a new national lung transplant allocation policy. The goal was to develop a point system that would prioritize candidates on the waiting list in a way that would yield more efficient and equitable outcomes. Our joint Massachusetts Institute of Technology (MIT)/UNOS team joined forces with the OPTN Lung Transplantation Committee in these policy design efforts. We discuss how our team applied a novel analytical framework, which was developed at MIT and utilizes optimization, regression, and simulation techniques, to illuminate salient trade-offs among outcomes and guide the choice of how to weigh different point attributes in the allocation formula. The committee selected for the allocation formula weights that were highlighted in the team’s analysis. The team’s proposal was implemented as the national lung allocation policy on March 9, 2023 across the United States. History: This paper has been accepted for the INFORMS Journal on Applied Analytics Special Issue—2022 Daniel H. Wagner Prize for Excellence in the Practice of Advanced Analytics and Operations Research.

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6

Scandling, John D., and Douglas J. Norman. "United Network for Organ Sharing (UNOS) Organ Allocation Policy and Kidney Utilization." American Journal of Kidney Diseases 56, no. 1 (July 2010): 7–9. http://dx.doi.org/10.1053/j.ajkd.2010.04.004.

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7

Arnaoutakis, G. J., T. J. George, A. Kilic, C. A. Merlo, and A. S. Shah. "449 Regional Differences in United States Lung Transplantation According to UNOS Geographic Regions." Journal of Heart and Lung Transplantation 30, no. 4 (April 2011): S153. http://dx.doi.org/10.1016/j.healun.2011.01.458.

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8

Lehman, R. R., K. Uccellini, E. Lease, R. Daly, and K. M. Chan. "Increasing Use of EVLP in the United States: Data from the OPTN/UNOS." Journal of Heart and Lung Transplantation 38, no. 4 (April 2019): S55. http://dx.doi.org/10.1016/j.healun.2019.01.121.

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9

Sachdeva, Mala. "Weight trends in United States living kidney donors: Analysis of the UNOS database." World Journal of Transplantation 5, no. 3 (2015): 137. http://dx.doi.org/10.5500/wjt.v5.i3.137.

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10

Norman, D. J. "Racial inequities in kidney transplantation: the UNOS perspective. United Network for Organ Sharing." JAMA: The Journal of the American Medical Association 271, no. 18 (May 11, 1994): 1402–3. http://dx.doi.org/10.1001/jama.271.18.1402.

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11

Reich, Heidi J., Joshua L. Chan, Lawrence S. C. Czer, James Mirocha, Alagappan A. Annamalai, Wen Cheng, Stanley C. Jordan, George Chaux, and Danny Ramzy. "Combined Lung-Kidney Transplantation: An Analysis of the UNOS/OPTN Database." American Surgeon 81, no. 10 (October 2015): 1047–52. http://dx.doi.org/10.1177/000313481508101027.

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Poor outcomes after thoracic transplantation with concurrent renal dysfunction are well described: without transplantation or with thoracic-only transplantation, patients face unacceptably high mortality. Outcomes after combined lung-kidney transplantation (LKT) remain largely uninvestigated. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was queried to identify all LKTs, lung transplantations (LTs), and kidney transplantations (KTs) performed in the United States from 1995 to 2013. Survival was calculated using the Kaplan-Meier method and compared using log-rank tests or Cox regression models. Thirty-one LKTs were performed. Mean recipient age was 45.4 ± 13.5 years; 48.3 per cent were male. Retransplantation for graft failure was the leading indication for LT (n = 13) and the most common renal indication was calcineurin inhibitor nephrotoxicity (n = 11). Mean lung allocation score was 46.6 ± 14.4, mean creatinine was 3.7 ± 2.8 g/dL, and glomerular filtration rate was 23.1 (interquartile range 11.9, 38.3) mL/min/1.7 m2, and 11 (35.5%) were dialysis dependent. Patient survival after LKT was 92.9 per cent, 71.0 per cent, and 71.0 per cent at one month, six months, and one year, with a median survival of 95.2 months. One- and five-year survival after LKT, 71.0 per cent and 59.9 per cent, were similar to LT (n = 23,913), 81.7 per cent and 51.4 per cent ( P = 0.061 and 0.55), and inferior to KT (n = 175,269), 94.9 per cent and 82.8 per cent ( P < 0.0001), respectively. Patient survival after LKT was similar to isolated LT, and these results suggest that LKT is a feasible therapeutic option for LT candidates with significant renal dysfunction.

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Briasoulis, Alexandros, Emmanuel Akintoye, and Paulino Alvarez. "OUTCOMES OF COMBINED ORGAN TRANSPLANTATION: AN ANALYSIS OF UNITED NETWORK FOR ORGAN SHARING (UNOS)." Journal of the American College of Cardiology 75, no. 11 (March 2020): 689. http://dx.doi.org/10.1016/s0735-1097(20)31316-4.

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13

Venugopal, S., E. Stoner, M. Deng, R. Menezes, and M. Cadeiras. "The United States Heart and Lung Transplant “Social” Network. Insights from the UNOS Database." Journal of Heart and Lung Transplantation 32, no. 4 (April 2013): S159—S160. http://dx.doi.org/10.1016/j.healun.2013.01.371.

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14

Briasoulis, A., E. Akintoye, and P. Alvarez. "Outcomes of Heart Re-Transplantation: Analysis of the United Network for Organ Sharing (UNOS)." Journal of Heart and Lung Transplantation 39, no. 4 (April 2020): S286—S287. http://dx.doi.org/10.1016/j.healun.2020.01.632.

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15

Shuhaiber, J. H., J. B. Kim, and R. Gibbons. "410: Repeat heart-lung transplantation outcome United States: An update from the UNOS registry." Journal of Heart and Lung Transplantation 26, no. 2 (February 2007): S207—S208. http://dx.doi.org/10.1016/j.healun.2006.11.432.

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16

Gharibi, Zahra, and Michael Hahsler. "A Simulation-Based Optimization Model to Study the Impact of Multiple-Region Listing and Information Sharing on Kidney Transplant Outcomes." International Journal of Environmental Research and Public Health 18, no. 3 (January 20, 2021): 873. http://dx.doi.org/10.3390/ijerph18030873.

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More than 8000 patients on the waiting list for kidney transplantation die or become ineligible to receive transplants due to health deterioration. At the same time, more than 4000 recovered kidneys from deceased donors are discarded each year in the United States. This paper develops a simulation-based optimization model that considers several crucial factors for a kidney transplantation to improve kidney utilization. Unlike most proposed models, the presented optimization model incorporates details of the offering process, the deterioration of patient health and kidney quality over time, the correlation between patients’ health and acceptance decisions, and the probability of kidney acceptance. We estimate model parameters using data obtained from the United Network of Organ Sharing (UNOS) and the Scientific Registry of Transplant Recipients (SRTR). Using these parameters, we illustrate the power of the simulation-based optimization model using two related applications. The former explores the effects of encouraging patients to pursue multiple-region waitlisting on post-transplant outcomes. Here, a simulation-based optimization model lets the patient select the best regions to be waitlisted in, given their demand-to-supply ratios. The second application focuses on a system-level aspect of transplantation, namely the contribution of information sharing on improving kidney discard rates and social welfare. We investigate the effects of using modern information technology to accelerate finding a matching patient to an available donor organ on waitlist mortality, kidney discard, and transplant rates. We show that modern information technology support currently developed by the United Network for Organ Sharing (UNOS) is essential and can significantly improve kidney utilization.

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17

Effenberger, Maria, Andreas Kronbichler, Erica Bettac, Felix Grabherr, Christoph Grander, Timon Erik Adolph, Gert Mayer, Heinz Zoller, Paul Perco, and Herbert Tilg. "Using Infodemiology Metrics to Assess Public Interest in Liver Transplantation: Google Trends Analysis." Journal of Medical Internet Research 23, no. 8 (August 17, 2021): e21656. http://dx.doi.org/10.2196/21656.

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Background Liver transplantation (LT) is the only curative treatment for end-stage liver disease. Less than 10% of global transplantation needs are met worldwide, and the need for LT is still increasing. The death rates on the waiting list remain too high. Objective It is, therefore, critical to raise awareness among the public and health care providers and in turn increasingly acquire donors. Methods We performed a Google Trends search using the search terms liver transplantation and liver transplant on October 15, 2020. On the basis of the resulting monthly data, the annual average Google Trends indices were calculated for the years 2004 to 2018. We not only investigated the trend worldwide but also used data from the United Network for Organ Sharing (UNOS), Spain, and Eurotransplant. Using pairwise Spearman correlations, Google Trends indices were examined over time and compared with the total number of liver transplants retrieved from the respective official websites of UNOS, the Organización Nacional de Trasplantes, and Eurotransplant. Results From 2004 to 2018, there was a significant decrease in the worldwide Google Trends index from 78.2 in 2004 to 20.5 in 2018 (–71.2%). This trend was more evident in UNOS than in the Eurotransplant group. In the same period, the number of transplanted livers increased worldwide. The waiting list mortality rate was 31% for Eurotransplant and 29% for UNOS. However, in Spain, where there are excellent awareness programs, the Google Trends index remained stable over the years with comparable, increasing LT numbers but a significantly lower waiting list mortality (15%). Conclusions Public awareness in LT has decreased significantly over the past two decades. Therefore, novel awareness programs should be initialized.

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Sokolich, Julio, Jacentha Buggs, Michael LaVere, Kobe Robichaux, Ebonie Rogers, Samantha Nyce, Ambuj Kumar, and Victor Bowers. "HCC Liver Transplantation Wait List Dropout Rates Before and After the Mandated 6-Month Wait Time." American Surgeon 86, no. 11 (August 19, 2020): 1592–95. http://dx.doi.org/10.1177/0003134820942165.

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Background Studies have shown significant improvement in hepatocellular carcinoma (HCC) recurrence rates after liver transplantation since the united network of organ sharing (UNOS) implementation of a 6-month wait period prior to accrued exception model for end-stage liver disease (MELD) points enacted on October 8, 2015. However, few have examined the impact on HCC dropout rates for patients awaiting liver transplant. Our objective is to evaluate the outcomes of HCC dropout rates before and after the mandatory 6-month wait policy enacted. Methods We conducted a retrospective cohort study on adult patients added to the liver transplant wait list between January 1, 2012, and March 8, 2019 (n = 767). Information was obtained through electronic medical records and organ procurement and transplant network (OPTN) publicly available national data reports. Results In response to the 2015 UNOS-mandated 6-month wait time, dropout rates in the HCC patient population at our center increased from 12% pre-mandate to 20.8% post-mandate This increase was similarly reflected in the national dropout rate, which also increased from 26.3% pre-mandate to 29.0% post-mandate. Discussion From these changes, it is evident that the UNOS mandate achieved its goal of increasing equity of liver organ allocation, but HCC patients are nonetheless dropping off of the wait list at an increased rate and are therefore disadvantaged.

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Doulamis, Ilias P., BoChang Wu, Armaan F. Akbar, Andreas Xanthopoulos, Emmanuel Androulakis, and Alexandros Briasoulis. "Pacemaker Implantation following Heart Transplantation: Analysis of a Nation-Wide Database." Journal of Clinical Medicine 12, no. 4 (February 17, 2023): 1604. http://dx.doi.org/10.3390/jcm12041604.

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Background: The 2018 United-Network-for-Organ-Sharing (UNOS) allocation-system changes resulted in greater recognition of mechanical circulatory support (MCS), leading to more heart transplantations (HTx) in patients with MCS. We aimed to investigate the effect of the new UNOS allocation system on the need for a permanent pacemaker and associated complications following HTx. Methods: The UNOS Registry was questioned, to identify patients that received HTx in the US between 2000 and 2021. The primary objectives were to identify risk factors for the need for a pacemaker implantation following HTx. Results: 49,529 HTx patients were identified, 1421 (2.9%) requiring a pacemaker post-HTx. Patients who required a pacemaker were older (53.9 ± 11.5 vs. 52.6 ± 12.8 years, p < 0.001), more frequently white (73% vs. 67%; p < 0.001) and less frequently black (18% vs. 20%; p < 0.001). In the pacemaker group, UNOS status 1A (46% vs. 41%; p < 0.001) and 1B (31% vs. 27%; p < 0.001) were more prevalent, and donor age was higher (34.4 ± 12.4 vs. 31.8 ± 11.5 years; p < 0.001). One-year survival was no different between the groups (HR: 1.08; 95% CI: 0.85, 1.37; p = 0.515). An era effect was observed (per year: OR: 0.97; 95% CI: 0.96, 0.98; p = 0.003), while ECMO pre-transplant was associated with lower risk of a pacemaker (OR: 0.41; 95% CI: 0.19, 0.86; p < 0.001). Conclusions: While associated with various patient and transplant characteristics, pacemaker implantation does not seem to impact one-year survival after HTx. The need for pacemaker implantation was lower in the more recent era and in patients who required ECMO pre-transplant, a finding explained by recent advances in perioperative care.

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Taylor, Gloria, Lin Johnson McGaw, Gwen Mayes, Thomas J. Cossé, and Terry M. Weisenberger. "The Coordinator Attrition Problem in the United States: Myth or Reality?" Journal of Transplant Coordination 8, no. 2 (June 1998): 88–92. http://dx.doi.org/10.1177/090591999800800206.

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Excessive attrition among organ procurement coordinators has been a suspected problem for many years. In 1994 the United Network for Organ Sharing undertook a procurement coordinator attrition study. Initially, focus groups were conducted in conjunction with the 1994 North American Transplant Coordinators Organization's annual meeting. In 1996, 69 executive directors from organ procurement organizations were surveyed on the subject of procurement coordinator attrition. Thirty-five executive directors responded, resulting in a 51% response rate. The UNOS procurement coordinator attrition study explored actual attrition rates, relationships of certain demographic factors to attrition rates, economic impact of attrition on the organizations, and various job tenure issues. The period under study was January 1, 1990 through December 31, 1993. Results did not demonstrate an industry-wide attrition problem. Additionally, the study revealed no enduring attrition problem in any single organization, and some organizations were found to have no attrition during the entire study period.

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Burdick, James. "Response to “A Critique of UNOS Liver Allocation Policy” by Kenneth Einar Himma (CQ Vol 8, No 3)." Cambridge Quarterly of Healthcare Ethics 9, no. 2 (April 2000): 275–80. http://dx.doi.org/10.1017/s0963180100212139.

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The critique of the United Network for Organ Sharing (UNOS) liver allocation policy by Kenneth Himma has flaws related to the complexities and evolutionary nature of the field. Recent improvements in transplantation have achieved national attention of this sort. There has been an evolution, unequaled elsewhere in medicine, of a national data set and national rules. The transplant community might have been more effective in communicating the details of this, and the problems associated with organ allocation policy. The novelty and complexity of the new rules understandably can produce misleading conclusions.

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Dharnidharka, Vikas R., Gary Stevens, and Richard J. Howard. "En-Bloc Kidney Transplantation in the United States: An Analysis of United Network of Organ Sharing (UNOS) Data from 1987 to 2003." American Journal of Transplantation 5, no. 6 (June 2005): 1513–17. http://dx.doi.org/10.1111/j.1600-6143.2005.00878.x.

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23

Briasoulis, Alexandros, Emmanuel Akintoye, Suchith Shetty, and Paulino Alvarez. "TRENDS AND OUTCOMES OF HEART RE-TRANSPLANTATION: INSIGHTS FROM THE UNITED NETWORK FOR ORGAN SHARING (UNOS)." Journal of the American College of Cardiology 75, no. 11 (March 2020): 747. http://dx.doi.org/10.1016/s0735-1097(20)31374-7.

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Kilic, A., G. J. Arnaoutakis, T. J. George, E. S. Weiss, J. V. Conte, D. D. Yuh, and A. S. Shah. "371 Lung Retransplantation: Predictors of Improved Survival from the United Network for Organ Sharing (UNOS) Database." Journal of Heart and Lung Transplantation 30, no. 4 (April 2011): S128. http://dx.doi.org/10.1016/j.healun.2011.01.379.

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25

Sethi, J., G. A. Garrido Rosa, K. Patel, and N. Sharma. "Predicting Long Term Survival in Lung Transplant: Analysis of United Network for Organ Sharing (UNOS) Database." Journal of Heart and Lung Transplantation 38, no. 4 (April 2019): S331. http://dx.doi.org/10.1016/j.healun.2019.01.836.

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Roberts, Mark S., Derek C. Angus, Cindy L. Bryce, Zdenek Valenta, and Lisa Weissfeld. "Survival after liver transplantation in the United States: A disease-specific analysis of the UNOS database." Liver Transplantation 10, no. 7 (2004): 886–97. http://dx.doi.org/10.1002/lt.20137.

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Kronbichler, Andreas, Maria Effenberger, Jae Il Shin, Christian Koppelstätter, Sara Denicolò, Michael Rudnicki, Hannes Neuwirt, et al. "Is There Decreasing Public Interest in Renal Transplantation? A Google TrendsTM Analysis." Journal of Clinical Medicine 9, no. 4 (April 7, 2020): 1048. http://dx.doi.org/10.3390/jcm9041048.

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Background and objectives: Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. Design, setting, participants, and measurements: We performed a Google TrendsTM search with the search term “kidney transplantation” between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. Results: During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of −50.9% and a relative reduction by −66.7%. The trend was even more pronounced for the UNOS area (−75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. Conclusions: This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.

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Miyamoto, Takuma, Christopher David Pritting, Rob Tatum, Danial Ahmad, Yevgeniy Brailovsky, Mahek K. Shah, Indranee Rajapreyar, et al. "Characterizing Adaptive Changes and Patient Survival After 2018 Donor Allocation Restructuring: A UNOS Database Analysis." Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine 23, no. 2 (May 22, 2024): 81–88. http://dx.doi.org/10.1097/hpc.0000000000000359.

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Purpose: We sought to characterize adaptive changes to the revised United Network for Organ Sharing donor heart allocation policy and estimate long-term survival trends for heart transplant (HTx) recipients. Methods: Patients listed for HTx between October 17, 2013 and September 30, 2021 were identified from the United Network for Organ Sharing database, and stratified into pre- and postpolicy revision groups. Subanalyses were performed to examine trends in device utilization for extracorporeal membranous oxygenation (ECMO), durable left ventricular assist device (LVAD), intra-aortic balloon pump (IABP), microaxial support (Impella), and no mechanical circulatory support (non-MCS). Survival data post-HTx were fitted to parametric distributions and extrapolated to 5 years. Results: We identified 27,523 HTx waitlist candidates during the study period, most of whom (n = 16,376) were waitlisted in the prepolicy change period. Overall, 19,554 patients underwent HTx during the study period (pre: 12,037 and post: 7517). Listings increased after the policy change for ECMO (P < 0.01), Impella (P < 0.01), and IABP (P < 0.01) patients. Listings for LVAD (P < 0.01) and non-MCS (P < 0.01) patients decreased. HTx increased for ECMO (P < 0.01), Impella (P < 0.01), and IABP (P < 0.01) patients after the policy change and decreased for LVAD (P < 0.01) and non-MCS (P < 0.01) patients. Waitlist survival increased for the overall (P < 0.01), ECMO (P < 0.01), IABP (P < 0.01), and non-MCS (P < 0.01) groups. Waitlist survival did not differ for the LVAD (P = 0.8) and Impella (P = 0.1) groups. Post-transplant survival decreased for the overall (P < 0.01), LVAD (P < 0.01), and non-MCS (P < 0.01) populations. Conclusions: Allocation policy revisions have contributed to greater utilization of ECMO, Impella, and IABP, decreased utilization of LVADs and non-MCS, increased waitlist survival, and decreased post-HTx survival.

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Suri, Jaspreet S., Christopher J. Danford, Vilas Patwardhan, and Alan Bonder. "Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease." Journal of Clinical Medicine 9, no. 2 (January 23, 2020): 319. http://dx.doi.org/10.3390/jcm9020319.

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Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. Methods: We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Results: Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85–1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Conclusion: Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.

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Krishnan, Mridula, Laila Gharzai, Ahmad Qurie, Osama Diab, Mahesh Anantha Narayanan, Renuga Vivekanandan, and Ryan W. Walters. "Incidence of colorectal carcinoma following liver transplantation: A retrospective analysis using the United Network for Organ Sharing (UNOS) database." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 542. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.542.

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542 Background: Since 1988, approximately 145,000 liver transplants (LT) have been performed in the United States, with 7,127 in 2015 alone. Several malignancies occur more frequently in solid organ transplant recipients. Studies have shown increased risk of Colorectal cancer (CRC) post LT in adults with primary sclerosing cholangitis, whether the risk of de novo CRC is increased or not remains controversial. Methods: A retrospective analysis was conducted using the UNOS database. Between-group differences in CRC rates were compared using Fisher’s exact test whereas, the differences in observed years between liver transplant and CRC were compared using negative binomial regression models. Results: We retrospectively analyzed 12,337 recipients of LT within the UNOS database. The overall incidence of CRC post LT was estimated to be at 3.8 percent. Interestingly, the incidence was higher in women and non-obese recipients. All immunosuppressive agents within the limits of the database were analysed for maintenance and anti-rejection. The two agents with some increase in incidence were cyclosporine and cellcept but this was statistically insignificant.(Table 1) Women and elderly ( > 65 years) were likely to develop CRC approximately 25 percent earlier than men and younger patients (p = 0.003 and p = 0.001, respectively). Conclusions: Studies have shown a trend toward increased incidence of CRC post LT. These studies were limited by the sample size and were single-center trials. To date there are no elaborate guidelines on surveillance of CRC in LT recipients. In our study there was a shorter interval to development of CRC in older patients and women, suggesting that this population may benefit from early initiation of screening. [Table: see text]

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Phan, D. K., P. Friedmann, J. P. Skendelas, A. Mansour, J. Borgi, S. Alsunaid, M. Abbasi, and S. J. Forest. "The United States Experience of Lung Transplantation in Recipients with COVID-19 Fibrosis: A UNOS/OPTN Analysis." Journal of Heart and Lung Transplantation 41, no. 4 (April 2022): S109—S110. http://dx.doi.org/10.1016/j.healun.2022.01.255.

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Gill, Jagbir, Yong W. Cho, Gabriel M. Danovitch, Alan Wilkinson, Gerald Lipshutz, Phuong-Thu Pham, John S. Gill, Tariq Shah, and Suphamai Bunnapradist. "Outcomes of Dual Adult Kidney Transplants in the United States: An Analysis of the OPTN/UNOS Database." Transplantation 85, no. 1 (January 2008): 62–68. http://dx.doi.org/10.1097/01.tp.0000296855.44445.af.

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Pruett, T. L. "Liver transplantation for childhood hepatic malignancy: a review of the United Network for Organ Sharing (UNOS) database." Yearbook of Surgery 2007 (January 2007): 113–14. http://dx.doi.org/10.1016/s0090-3671(08)70086-7.

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Austin, Mary T., Charles M. Leys, Irene D. Feurer, Harold N. Lovvorn, James A. O'Neill, C. Wright Pinson, and John B. Pietsch. "Liver transplantation for childhood hepatic malignancy: a review of the United Network for Organ Sharing (UNOS) database." Journal of Pediatric Surgery 41, no. 1 (January 2006): 182–86. http://dx.doi.org/10.1016/j.jpedsurg.2005.10.091.

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Basu, A., N. Kohn, M. Bhaskaran, N. Ali, J. Rosado, E. Siskind, M. Barlow, et al. "Dual Adult Kidney Transplants (DKT):Analysis of the United Network of Organ Sharing (UNOS) Database 2006-2011." Transplantation 98 (July 2014): 137. http://dx.doi.org/10.1097/00007890-201407151-00422.

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Al-Kindi, Sadeer, Marwan Qattan, Joyce Njoroge, Chantal ElAmm, Mahazarin Ginwalla, and Guilherme H. Oliveira. "Familial Cardiomyopathy is Associated with Better Cardiac Allograft Survival: Analysis from United Network for Organ Sharing (UNOS)." Journal of Cardiac Failure 20, no. 8 (August 2014): S30. http://dx.doi.org/10.1016/j.cardfail.2014.06.087.

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Hashmi, Shahrukh, Timucin Taner, Mrinal Patnaik, Michael Leise, Matthew Hathcock, Walter K. Kremers, William Hogan, and Mark R. Litzow. "Liver Transplantation for Hepatic Graft-Versus-Host-Disease: A United Network for Organ Sharing (UNOS) Database Study." Biology of Blood and Marrow Transplantation 21, no. 2 (February 2015): S331. http://dx.doi.org/10.1016/j.bbmt.2014.11.528.

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Al-Kindi, Sadeer G., Iqbal El-Assaad, Charbel Abi Khalil, and Guilherme H. Oliveira. "Heart transplantation of Middle Eastern patients in the United States: A brief report from the UNOS database." Journal of Heart and Lung Transplantation 34, no. 9 (September 2015): 1219–20. http://dx.doi.org/10.1016/j.healun.2015.06.005.

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Trivedi, Jaimin R., Siddharth V. Pahwa, Katherine R. Whitehouse, Bradley M. Ceremuga, and Mark S. Slaughter. "Racial disparities in cardiac transplantation: Chronological perspective and outcomes." PLOS ONE 17, no. 1 (January 26, 2022): e0262945. http://dx.doi.org/10.1371/journal.pone.0262945.

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Background The objective of this study was to evaluate annual heart transplant volumes and 3-year post-transplant outcomes since establishment of United Network for Organ Sharing (UNOS) database stratified by race. Methods The UNOS thoracic transplant database was evaluated for adult patients since 1987. The available database was then stratified by Race: Black, White and Other and era of transplant: group 1(1987–1991), group 2(1992–1996), group 3(1997–2001), group 4(2002–2006), group 5(2007–2011), group 6(2012–2016) and group 7(2017 and later). Demographic and clinical factors were evaluated. Results A total of 105,266 adults have been listed since 1987 and 67,824 have been transplanted. Of the transplanted patients 11,235 were Black, 48,786 White and 6803 were of Other race. The proportion of Black patients listed increased from 7% in 1987 to 13.4% in 1999 and 25% in 2019 and those transplanted increased from 5% in 1987 to 13.4% in 2001 and 26% in 2019. The survival of Black patients gradually improved. Conclusion Historically, fewer Black patients received cardiac transplantation however, their access gradually improved over the years and account for over 25% of cardiac transplantations performed in recent years. The historically poor survival of Black patients has recently improved and became comparable to the rest.

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Jahanyar, Jama, Michael M. Koerner, Ali Ghodsizad, Matthias Loebe, and George P. Noon. "Heterotopic Heart Transplantation: The United States Experience." Heart Surgery Forum 17, no. 3 (July 3, 2014): 132. http://dx.doi.org/10.1532/hsf98.2014328.

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<p><b>Introduction:</b> More than 3 decades have passed since the first heterotopic heart transplantation (HHT) was reported. Nowadays, this surgical technique is used rarely, and only in patients who do not qualify for standard orthotopic heart transplantation (OHT). Current indications mainly comprise refractory pulmonary hypertension and a donor-recipient size mismatch (>20%). The objective of this study was to analyze the United States experience with HHT.</p><p><b>Patients and Methods:</b> The United Network for Organ Sharing (UNOS) database between 1987 and 2007 was analyzed. Patients who underwent heart transplantation were enrolled in this study. Patients with missing transplant dates or history of retransplantation were excluded.</p><p><b>Results:</b> A total of 41,379 patients underwent OHT and 178 HHT; 32,361 and 111 patients, respectively, were enrolled. Overall 1-, 5-, and 10-year survival was significantly (<i>P</i> < .001) better in OHT (87.7%, 74.4%, 54.4%) than HHT patients (83.8%, 59%, 35.1%). Survival in patients with transpulmonary gradients (TPG) >15 mmHg was 86.6 %, 73.3%, and 57.4% in the OHT and 93.8%, 64.8%, and 48.6% in the HHT group (<i>P</i> = .35). Pretransplant criteria (HHT versus OHT) with statistically significant differences (<i>P</i> < .05) were as follows (mean + SD): recipient weight, 78.9 + 19.9 versus 74.1 + 23.4 kg; recipient height, 174.9 + 13.9 versus 168 + 25.1 cm; and TPG 12.1 + 7.2 versus 9.6 + 6.3 mmHg.</p><p><b>Conclusions:</b> The results show that HHT remains a feasible option in a highly selected patient population, with overall good results.</p>

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Rosenthal, Lori. "The Ethical Implications of Liver Transplantation in Patients With a Large Burden of Hepatocellular Carcinoma." Clinical Scholars Review 4, no. 1 (2011): 22–27. http://dx.doi.org/10.1891/1939-2095.4.1.22.

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This review discusses extending liver transplantation to patients with hepatocellular carcinoma (HCC) beyond established United Network for Organ Sharing (UNOS) criteria. After a thorough review of the literature, ethical issues are discussed with particular attention to informed decision making regarding autonomy and paternalism, especially considering patients without preexisting medical knowledge may have difficulty making informed decisions in times of emotional stress and facing an otherwise terminal illness. Additionally, a discussion of just organ allocation is addressed during a time of deceased organ scarcity. These issues are examined while addressing the use of extended donors. Acknowledging these issues are necessary for the practice of clinicians who advise, educate, and manage patients with HCC requiring liver transplantation.

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Basu, A., N. Kohn, M. Bhaskaran, N. Ali, E. Siskind, M. Barlow, R. Schwarz, et al. "Resource Use in Adult Dual Kidney Transplantation(DKT): Analysis of the United Network of Organ Sharing(UNOS) Database." Transplantation 98 (July 2014): 598. http://dx.doi.org/10.1097/00007890-201407151-02018.

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Mancini, M. J., A. F. Connors Jr., X. Q. Wang, S. Nock, C. Spencer, C. McCullough, P. Lobo, and R. Isaacs. "HLA matching for simultaneous pancreas- kidney transplantation in the United States: a multivariable analysis of the UNOS data." Clinical Nephrology 57, no. 01 (January 1, 2002): 27–37. http://dx.doi.org/10.5414/cnp57027.

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Rasmusson, K. D., D. G. Renlund, B. D. Horne, K. D. Brunisholz, S. A. Brush, P. W. Fisher, M. M. Endo, et al. "147: Outcomes of Heart Transplantation for Peripartum Cardiomyopathy: Analysis of the United Network for Organ Sharing (UNOS) Database." Journal of Heart and Lung Transplantation 28, no. 2 (February 2009): S117. http://dx.doi.org/10.1016/j.healun.2008.11.825.

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Mehta, Aneesh K., Maricar Malinis, Gabriel Vece, Lara Danziger-Isakov, Diana F. Florescu, Marian Michaels, Cameron R. Wolfe, Lynne Strasfeld, and Susan Tlusty. "1733. 10 Years of DTAC Experience With Donor-Derived Cryptococcus Transmission in Solid-Organ Transplantation in the United States." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S59. http://dx.doi.org/10.1093/ofid/ofy209.139.

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Abstract Background Cryptococcosis is an important fungal complication of solid organ transplantation (SOT); cases occurring within 6 months posttransplant are often severe and sometimes donor derived. Morbidity can be related to delayed recognition of clinical symptoms or lack of communications among the SOT recipient centers. To better understand transmission of Cryptococcus (Crypto) and to identify opportunities for improved identification and communication, all potential donor-derived transmission events (PDDTE) of Crypto reported to OPTN/UNOS ad hoc Disease Transmission Advisory Committee (DTAC) over 10 years were analyzed. Methods All Crypto cases reported to DTAC between January 2008 and December 2017 were reviewed retrospectively as potential donor-derived transmission events (PDDTE). Likelihood of donor-derivation was adjudicated based on recipient and donor data. Results Fourty-six cases of Crypto were reported to DTAC during this period, involving 145 SOT recipients. Of the Proven or Probable donor-derived Crypto cases (n = 9), transmission occurred in 15 recipients; 2 donors each transmitted Crypto to 3 different recipients. Of the Possible cases, 9 recipients were affected. Six recipients with PDDTE Crypto died. Eight recipients received antifungal medications that would prevent transmission of Crypto (classified as intervention without disease transmission). UNOS Region 7 had the highest number donors with 10, with 6 and 7 from Regions 2 and 3, respectively. No cases C. gattii were reported; however, most of the reports to DTAC did not discriminate between C. neoformans and C. gattii. Conclusion This DTAC case series highlights both donor and recipient-derived cryptococcal infections and their potential to have devastating clinical impact. These data also highlight important delays in recognizing Crypto in SOT and in communicating these results to other centers when a PDDTE is possible. Transplant teams should have a high level of suspicion for Crypto in SOT, particularly in those with fever of unknown etiology, pulmonary infiltrates, headaches, and mental status changes. In the future, it may be helpful for transplant center to perform specific testing to discriminate between Cryptococcus species to understand their differential impact in SOT. Disclosures D. F. Florescu, Astellas: Grant Investigator, Grant recipient. C. R. Wolfe, Merck: Scientific Advisor, Consulting fee.

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Kushner, Tatyana, Ben L. Da, Aryana Chan, Douglas Dieterich, Keith Sigel, and Behnam Saberi. "Liver Transplantation for Hepatitis D Virus in the United States: A UNOS Study on Outcomes in the MELD Era." Transplantation Direct 8, no. 1 (December 17, 2021): e1253. http://dx.doi.org/10.1097/txd.0000000000001253.

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Usatin, D. J., E. R. Perito, A. M. Posselt, and P. Rosenthal. "Under Utilization of Pancreas Transplants in Cystic Fibrosis Recipients in the United Network Organ Sharing (UNOS) Data 1987-2014." American Journal of Transplantation 16, no. 5 (February 15, 2016): 1620–25. http://dx.doi.org/10.1111/ajt.13630.

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Ison, M. G., J. Hager, E. Blumberg, J. Burdick, K. Carney, J. Cutler, J. M. DiMaio, et al. "Donor-Derived Disease Transmission Events in the United States: Data Reviewed by the OPTN/UNOS Disease Transmission Advisory Committee." American Journal of Transplantation 9, no. 8 (August 2009): 1929–35. http://dx.doi.org/10.1111/j.1600-6143.2009.02700.x.

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Farr, Maryjane, Lauren K. Truby, Joel Lindower, Ulrich Jorde, Samantha Taylor, Leway Chen, Alan Gass, et al. "Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset." American Journal of Transplantation 20, no. 2 (October 28, 2019): 525–29. http://dx.doi.org/10.1111/ajt.15597.

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Kumar, Sachin, Sadeer Al-Kindi, Mobolaji Ige, Chantal Elamm, Mahazarin Ginwalla, and Guilherme Oliveira. "UTILIZATION OF HEMODYNAMIC SUPPORT IN STATUS 1A PATIENTS AWAITING HEART TRANSPLANT: INSIGHT FROM UNITED NETWORK OF ORGAN SHARING (UNOS)." Journal of the American College of Cardiology 65, no. 10 (March 2015): A804. http://dx.doi.org/10.1016/s0735-1097(15)60804-x.

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