Trends in Outcomes of Heart Transplants Utilizing Extended Criteria Donors: A UNOS Database Analysis


While the utilization of extended criteria donors (ECDs) are traditionally avoided for poorer outcomes, management of HTx recipients has evolved over the past decades. We sought to examine the temporal trends in outcomes of ECDs in HTx.


We queried the UNOS database for adult HTx that fit the EXPAND Trial criteria for ECDs: ischemic time ≥ 4 hours, ejection fraction < 50%, age > 55 years, and history of coronary artery disease. Transplant years were stratified as follows: 2000-2004, 2005 – 2009, 2010 – 2014, and 2014 – 2018. Two-sample t-test, Kaplan Meier survival, log-rank test, analysis of variance, multivariable Cox proportional hazards, and Multinomial Logistic Regression were used to compare data between periods.


39,028 patients were stratified through Periods 1-4 as follows: 9,217 (2,942 ECD, 31.9%), 9,224 (2,730 ECD, 29.6%), 10,309 (2,762 ECD, 26.8%), and 10,278 (2,190 ECD, 21.3%). Transplants utilizing ECDs in Periods 1 and 2 had increased one-year mortality compared to Periods 3 and 4 (16.9% and 15.6% vs 11.9% and 10.9% respectively, P<0.001). Later periods also demonstrated improved Karnofsky scores (P<0.001).


While use of ECDs has decreased across the periods, we noted significant improvement in 1-year survival rate, as well as postoperative functional status.

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