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Donor heart scarcity remains the fundamental barrier to increased transplant access. We examined whether 2018 United Network for Organ Sharing (UNOS) policy changes have had an impact on donor heart acceptance rates.We performed an interrupted time series analysis in UNOS to evaluate for abrupt changes in donor heart-acceptance rates associated with the new policy. All adult donor offers were evaluated between 2015 and 2021 (n = 66,654 donors). Donor volumes and transplants increased during this period, but the donor acceptance rate declined significantly from 31% in quarter 3 of 2018 to 26% acceptance in quarter 3 of 2021 (slope change -0.4% per quarter; P0.001). We identified 2 trends associated with this decline: (1) a growing number of donors with high-risk features, and (2) decreased acceptance of donors with certain high-risk features in the new allocation system.Heart transplant volumes have increased in recent years as a result of increased donor volumes, but donor heart acceptance rates began decreasing under the current allocation system. Changes in the donor pool and acceptance patterns for certain donor-risk features may explain this shift and warrant further evaluation to maximize donor heart use.

Introduction Chronotropic incompetence is very common after heart transplant. The extent to which it affects the functional capacity of heart transplant patients is unknown. We hypothesize that a higher heart rate responsiveness would be associated with improved peak oxygen uptake and may have long-term prognostic impact. Methods We performed a retrospective analysis of all patients who underwent heart transplantation and cardiopulmonary exercise testing (CPET) in the first post-transplant year at a single large academic center between the year 2000 and 2011. Peak VO2 and total exercise time were assessed by CPET. Heart rate responsiveness was defined as the difference between peak and resting heart rate during CPET. The association of heart rate responsiveness with peak VO2 and total exercise time was analyzed using multivariable linear regression, and survival analysis was performed via a cox proportional hazard model. Results CPET was performed at our institution in 271 patients during the first year post heart transplantation at a median of 2.3 months. Subjects were 82% male, age 55 (IQR 45-61) at time of CPET. After multivariate adjustment, each ten beat/min increase in heart rate responsiveness was associated with a 0.9 ml/kg/min increase in peak oxygen consumption (p Conclusions Chronotropic incompetence after heart transplant is associated with decreased functional capacity but is not a prognostic indicator of mortality after transplant.

Background Early graft dysfunction after orthotopic heart transplantation is associated with worse survival and functional outcomes. However, the prognostic implication of acute cellular rejection (ACR) early after transplant is less well defined. Here, we analyzed the association between early ACR and post-transplant exercise capacity. Methods We performed a retrospective analysis of all heart transplant patients who underwent cardiopulmonary exercise testing (CPET) within a year of transplant at a single large academic center between 2000 and 2011. Early ACR was defined as cellular grade 2R or 3R histopathology seen on biopsy within 3 months of transplant. Exercise capacity was assessed during CPET by 1) peak VO2 and 2) total exercise time. CPET performed prior to diagnosis of rejection were excluded. The association between early ACR or grade of ACR and exercise parameters was analyzed using linear regression. Results A total of 230 patients (median age 55 [IQR 45-61], 79.6% male) who received a heart transplantation at our institution between 2000 and 2011 underwent CPET during the 1st year. Of these, 12% (n=40) developed early grade 2R rejection and 5% (n=12) developed early grade 3R rejection. No antibody mediated rejection (including hyperacute) was seen in this timeframe among patients who later underwent CPET. Neither peak VO2 (p=0.95) nor total exercise time (p=0.54) were predicted by early ACR of any grade. Conclusions Early cellular rejection does not predict worse exercise capacity in the first year after heart transplant. This inference is limited to patients who are able to undergo CPET.