TOPLINE: 

Physician assistant (PA)-led recovery teams for cardiac allograft yielded comparable outcomes to traditional physician-led teams, with no significant differences in rates of severe primary graft dysfunction (PGD) and 30-day survival, according to a retrospective single-center analysis.

METHODOLOGY: 

• Researchers conducted a retrospective study at the Vanderbilt University Medical Center, Nashville, Tennessee, including 497 adult patients (median age, 58.1 years; 24.7% women) with heart transplants performed between January 2020 and December 2024.
• The analysis compared 130 allografts recovered by PA-led teams with 367 recovered by non-PA-led teams, following the implementation of a PA-led recovery program in July 2022 staffed by an experienced, institutionally certified PA. Any team containing an attending cardiothoracic surgeon and PA were included in the non-PA group.
• Primary outcomes included severe PGD and the vasoactive inotrope score (VIS) at ICU arrival and 24 and 72 hours post-transplant.
• Secondary outcomes included lengths of ICU and hospital stay, cardiothoracic surgeons' efforts toward allograft recovery, and surgical injury-related graft nonrecovery.

TAKEAWAY:

• No significant differences were observed between the PA and non-PA groups in the rate of severe PGD among grafts (7.7% vs 5.2%; P = .28); the median VIS at ICU arrival (16.4 vs 16.4; P = .57), 24 hours (11.2 vs 11.5; P = .70), and 72 hours (6.2 vs 5.6; P = .28); and the 30-day survival rate (96.9% vs 96.5%; P > .99).
• The median length of ICU stay was longer in the PA group than in the non-PA group (8 days vs 7 days; P = .01), but the median length of hospital stay was not significantly different (19 days vs 17 days; P = .09).
• Implementation of the PA-led recovery model nonsignificantly reduced the participation of attending surgeons in allograft recovery by 19.1% per quarter (P = .054) and significantly decreased the time commitment of attending surgeons by 46.7 hours per quarter (P = .045).
• Overall, 57 unsuccessful cardiac allograft recoveries were staffed by PA-led teams, whereas 76 were unsuccessful with non-PA-led teams.

IN PRACTICE:

"Beyond safety, this approach demonstrated measurable programmatic benefits, including reduced surgeon workload and expanded transplantation for high sequence recipients," the authors wrote. They added, "as nontraditional recovery models become increasingly adopted in thoracic transplantation, these findings support the integration of experienced nonphysician recovery specialists as a viable and effective strategy to enhance transplant system efficiency without compromising patient outcomes."

SOURCE:

The study was led by Mark Petrovic, Vanderbilt University School of Medicine, Nashville, Tennessee. It was published online on November 11, 2025, in American Journal of Transplantation.

LIMITATIONS:

The single-center design of the study limited generalizability to other transplant centers with different volumes, staffing models, and institutional practices. The nonrandomized nature of recovery team assignment and potential experience bias due to the substantial prior expertise of PAs (over 200 thoracic organs recovered) limited establishing causal inferences. Additionally, era effects from the introduction of new preservation techniques and growing programmatic comfort for procurement of hearts from donors after circulatory death could have influenced outcomes. 

DISCLOSURES:

The study was supported by a grant from the American Heart Association. The authors declared no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.