BACKGROUND In 2016, we initiated a quality improvement endeavor to increase pediatric heart offer acceptance. This study assessed the effect of these interventions at our center. METHODS We evaluted pre- and postimplementation cohorts (January 1, 2008-December 31, 2016 vs January 1, 2017-July 1, 2023) comparing donor heart utilization. Six interventions were iterated over time to increase offer acceptance ("extended criteria"): ABO-incompatible transplant, ex vivo perfusion for distanced donors, 3-dimensional total cardiac volume (TCV) assessment, acceptance of hepatitis-C or Severe Acute Respiratory Syndrome Coronavirus 2 infected donors, and institutional culture change favoring consideration of donors previously considered unacceptable. Outcomes studied included annual HT volume, median waitlist duration, sequence number at acceptance, and post-transplant clinical outcomes. RESULTS During the study period, annual transplant volume increased from 16/year to 25/year pre- and postimplementation. Three hundred thirteen of 389 (80%) listed patients were transplanted. Waitlist duration shortened postimplementation (p = 0.01), as did the percentage of accepted heart offers utilizing at least 1 extended criterion (p < 0.001). Institutional culture change and TCV assessment had the largest impact on donor heart utilization (p = 0.04 and p < 0.001). There was no difference in post-HT intubation or intensive care unit days (p = 0.05-0.9), though post-transplant hospitalization duration (p < 0.001) increased. Post-transplant survival was unaffected by the use of extended criteria hearts (p = 0.3). CONCLUSIONS We report a successful longitudinal, multifaceted effort to increase organ offer utilization, with institutional culture change and TCV assessments most impactful. The use of extended criteria hearts was not associated with inferior survival.

中文翻译：

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提高儿科捐赠心脏利用率的全面、多方面的策略。


背景 2016 年，我们发起了一项质量改进工作，以提高儿科心脏报价的接受度。这项研究评估了我们中心这些干预措施的效果。方法 我们评估了实施前和实施后队列（2008年1月1日至2016年12月31日与2017年1月1日至2023年7月1日），比较供体心脏的利用率。随着时间的推移，重复了六种干预措施以提高接受度（“扩展标准”）：ABO 不相容移植、远距离供体的离体灌注、3 维总心脏容量 (TCV) 评估、接受丙型肝炎或严重急性呼吸综合征冠状病毒 2 感染的捐赠者，以及机构文化的变化有利于考虑以前认为不可接受的捐赠者。研究的结果包括年度 HT 量、中位等待时间、接受时的序列号和移植后临床结果。结果 在研究期间，实施前后的年移植量从 16 例/年增加到 25 例/年。所列 389 名患者中，有 313 名 (80%) 接受了移植。实施后候补名单的持续时间缩短了 (p = 0.01)，使用至少 1 个扩展标准的接受心脏报价的百分比也缩短了 (p < 0.001)。机构文化变化和 TCV 评估对供体心脏利用率影响最大（p = 0.04 和 p < 0.001）。尽管移植后住院时间 (p < 0.001) 增加，但 HT 插管后或重症监护病房天数没有差异 (p = 0.05-0.9)。移植后存活率不受使用扩展标准心脏的影响（p = 0.3）。结论 我们报告了成功的纵向、多方面的努力，以提高器官供应利用率，其中机构文化变革和 TCV 评估影响最大。 使用扩展标准心脏与较差的生存率无关。