{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T21:10:07Z","timestamp":1756501807415,"version":"3.44.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study evaluates changes in centre-level utilization of longer distance donors (LDD) in heart transplantation (HT) before and after the allocation policy change in 2018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Adult HT recipients from 2010 to 2023 were identified from the United Network for Organ Sharing registry. Patients were categorized based on donor centre distance and policy change. The Mann-Kendall trend test was utilized for trend analysis. A propensity-matched analysis was performed. Survival analyses were performed using Kaplan-Meier, restricted mean survival time, and multivariable Cox proportional models. Interaction analysis with Bonferroni correction and sensitivity analysis to test the robustness of primary findings were performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 32\u00a0036 recipients from 152 centres, 29\u00a0410 from \u2264500 miles and 2626 from &amp;gt;500 miles. The mean distance increased from 171 miles to 288 (P\u2009&amp;lt;\u2009.001) and mean cold ischaemia time from 3.20 to 3.60 h (P\u2009&amp;lt;\u2009.001) after allocation change. The proportion of recipients with LDD increased from 5.50% in 2010 to 14.00% in 2022, P\u2009=\u2009.021. In the unmatched cohort, unadjusted 30-day, 1-year, and 5-year survival was comparable between LDD and non-LDD recipients (P\u2009&amp;gt;\u2009.05). However, risk-adjusted survival in the matched cohort was significantly better with LDD: 30-day (0.60, 0.43-0.82, P\u2009=\u2009.002), 1-year (0.67, 0.55-0.82, P\u2009&amp;lt;\u2009.001), and 5-y (0.75, 0.65-0.86, P\u2009&amp;lt;\u2009.001). Similar findings persisted even after restricted mean survival time analysis. There was a weak correlation between distance and ischaemia time in the matched cohort (r\u2009=\u20090.19).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There has been a substantial increase in the use of LDD following the allocation change. Distance is not a surrogate for ischaemia time. Survival after HT with LDD use is significantly better compared to non-LDD, but further research is warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf190","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T14:48:21Z","timestamp":1755528501000},"source":"Crossref","is-referenced-by-count":0,"title":["Evolving Changes in Centre-Level Utilization of Longer Distance Donors in Heart Transplantation"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7531-6614","authenticated-orcid":false,"given":"Krishna","family":"Bhandari","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Shorbaji","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akinwale Victor","family":"Famotire","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Welch","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"Witer","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Pope","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8112-8345","authenticated-orcid":false,"given":"Arman","family":"Kilic","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Medical University of South Carolina , Charleston, SC 29425,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"2025082916461329500_ivaf190-B1","doi-asserted-by":"publisher","first-page":"S305","DOI":"10.1016\/j.ajt.2024.01.016","article-title":"OPTN\/SRTR 2022 annual data report: heart","volume":"24","author":"Colvin","year":"2024","journal-title":"Am J Transplant"},{"key":"2025082916461329500_ivaf190-B2","doi-asserted-by":"publisher","first-page":"2685","DOI":"10.1111\/jocs.16668","article-title":"Ischemic time and patient outcomes after the 2018 UNOS donor heart allocation system change","volume":"37","author":"Siddiqi","year":"2022","journal-title":"J Card Surg"},{"key":"2025082916461329500_ivaf190-B3","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1001\/jamacardio.2020.4909","article-title":"Evolving trends in adult heart transplant with the 2018 heart allocation policy change","volume":"6","author":"Kilic","year":"2021","journal-title":"JAMA Cardiol"},{"key":"2025082916461329500_ivaf190-B4","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1016\/S0140-6736(15)60038-1","article-title":"Adult heart transplantation with distant procurement and ex vivo preservation of donor hearts after circulatory death: a case series","volume":"385","author":"Dhital","year":"2015","journal-title":"Lancet"},{"key":"2025082916461329500_ivaf190-B5","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/ajt.12994","article-title":"Normothermic ex vivo perfusion provides superior organ preservation and enables viability assessment of hearts from DCD donors","volume":"15","author":"Iyer","year":"2015","journal-title":"Am J Transplant"},{"key":"2025082916461329500_ivaf190-B6","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1097\/MAT.0000000000002137","article-title":"Outcomes in heart transplant recipients by bridge to transplant strategy when using the SherpaPak cardiac transport system","volume":"70","author":"Silvestry","year":"2024","journal-title":"ASAIO J"},{"issue":"2 Pt 2","key":"2025082916461329500_ivaf190-B7","first-page":"I11","article-title":"Distant heart procurement for human transplantation. Ultrastructural studies","volume":"62","author":"Billingham","year":"1980","journal-title":"Circulation"},{"key":"2025082916461329500_ivaf190-B8","first-page":"56","article-title":"Distant heart procurement for transplantation","volume":"86","author":"Watson","year":"1979","journal-title":"Surgery"},{"key":"2025082916461329500_ivaf190-B9","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/j.healun.2017.07.019","article-title":"The registry of the international society for heart and lung transplantation: thirty-fourth adult heart transplantation report-2017; focus theme: allograft ischemic time","volume":"36","author":"Lund","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"2025082916461329500_ivaf190-B10","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1016\/j.athoracsur.2017.01.055","article-title":"The paradoxical relationship between donor distance and survival after heart 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