Reid Dale

All Publications

• Nonlinear effect of body mass index on postoperative survival following isolated heart transplantation. JHLT open Dale, R., Bahatyrevich, N., Leipzig, M., Currie, M. E. 2025; 7: 100172

  Abstract

  Guidelines regarding recipient's body mass index (BMI) for heart transplant are evolving with variable cutoffs depending on the country and institution. It is imperative to provide updated nonlinear estimates of postoperative risk attributable to a recipient's BMI to evaluate the relevance of existing cutoffs.A total of 30,787 patients were analyzed from the United Network for Organ Sharing (UNOS) database. Patients receiving an isolated heart transplant ages 18 and older since 2010 were included. Overall survival was the primary outcome. A multivariate Cox proportional hazards model was applied and included a penalized smoothing spline term for recipient BMI and risk factors such as diabetes. We assessed the overall significance of the nonlinear penalized spline terms using an asymptotic Wald test.The cohort consisted of 662 (2.2%) BMI <18.5, 9,359 (30%) BMI 18.5 to 24.9, 10,997 (36%) BMI 25 to 29.9, 9,550 (31%) BMI 30 to 39.9, and 206 (0.7%) BMI ≥40 patients. The nonlinear spline terms for recipient BMI were statistically significant (p < 0.01). The hazard ratio (HR) appeared to grow linearly in BMI at an inflection point of BMI = 26. No inflection point was observed at either of the International Society for Heart and Lung Transplantation recommended cutoffs of BMI = 30 (HR 1.11, confidence interval [CI] 1.07-1.15) or BMI = 35 (HR 1.29, CI 1.24-1.37).After multivariable adjustment, there is no sharp cutoff in survival risk at either BMI = 30 or BMI = 35. Unlike previously reported, postoperative survival risk grows approximately linearly in the BMI range from 26 to 40.

  View details for DOI 10.1016/j.jhlto.2024.100172

  View details for PubMedID 40144853

  View details for PubMedCentralID PMC11935512

• Sex-mismatching in isolated heart transplantation confers no postoperative risk. JHLT open Dale, R., Leipzig, M., Bahatyrevich, N., Pines, K., Chen, Q., Teuteberg, J., Joseph Woo, Y., Currie, M. 2024; 6: 100158

  Abstract

  For heart transplantation, optimal donor-recipient matching is an important factor in the ongoing development of the United Network for Organ Sharing (UNOS) continuous distribution framework. Donor-recipient sex-mismatch has decreased since the 1990s, but this may be related to the risk posed by size mismatching, particularly when donor hearts are undersized. Thus, the impact of sex-mismatching, controlling for other factors including size mismatch, is uncertain.Adult first-time, isolated heart transplant patients from the UNOS database between October 1, 1987 and December 31, 2022 were analyzed. Cohorts were separated into male and female recipients. Propensity score matching on known preoperative risk factors was performed. Equivalence testing via Two One-Sided Testing (TOST) was performed to assess between-arm equivalence in postoperative outcomes. Survival differences were measured by the between-arm ratio of restricted mean survival time and binary outcome differences by the odds ratio.In the propensity-matched cohort, we found significant equivalence between arms in both male (TOST p < 0.001) and female (TOST p < 0.001) recipients for overall survival at all temporal end-points, postoperative treatment for rejection within 1 year, and predischarge dialysis.Sex-mismatch in isolated heart transplantation confers no additional risk to postoperative outcomes when controlling for other factors, including size mismatch. Consequently, sex-mismatch should not factor into individual assessments of organ acceptance or be incorporated into any national organ allocation policy. Increasing the acceptance of sex-mismatched donors has the potential to expand the donor pool and increase female donor utilization.

  View details for DOI 10.1016/j.jhlto.2024.100158

  View details for PubMedID 40145045

  View details for PubMedCentralID PMC11935461

• Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States. BMC medical ethics Dale, R., Cheng, M., Pines, K. C., Currie, M. E. 2024; 25 (1): 115

  Abstract

  BACKGROUND: The Organ Procurement and Transplant Network (OPTN) Final Rule guides national organ transplantation policies, mandating equitable organ allocation and organ-specific priority stratification systems. Current allocation scores rely on mortality predictions.METHODS: We examined the alignment between the ethical priorities across organ prioritization systems and the statistical design of the risk models in question. We searched PubMed for literature on organ allocation history, policy, and ethics in the United States.RESULTS: We identified 127 relevant articles, covering kidney (19), liver (60), lung (24), and heart transplants (23), and transplant accessibility (1). Current risk scores emphasize model performance and overlook ethical concerns in variable selection. The inclusion of race, sex, and geographical limits as categorical variables lacks biological basis; therefore, blurring the line between evidence-based models and discrimination. Comprehensive ethical and equity evaluation of risk scores is lacking, with only limited discussion of the algorithmic fairness of the Model for End-Stage Liver Disease (MELD) and the Kidney Donor Risk Index (KDRI) in some literature. We uncovered the inconsistent ethical standards underlying organ allocation scores in the United States. Specifically, we highlighted the exception points in MELD, the inclusion of race in KDRI, the geographical limit in the Lung Allocation Score, and the inadequacy of risk stratification in the Heart Tier system, creating obstacles for medically underserved populations.CONCLUSIONS: We encourage efforts to address statistical and ethical concerns in organ allocation models and urge standardization and transparency in policy development to ensure fairness, equitability, and evidence-based risk predictions.

  View details for DOI 10.1186/s12910-024-01116-x

  View details for PubMedID 39420378

• Impacts of Positive Margins and Surgical Extent on Outcomes after Early-Stage Lung Cancer Resection. The Annals of thoracic surgery Wong, L. Y., Dale, R., Kapula, N., Elliott, I. A., Liou, D. Z., Backhus, L. M., Lui, N. S., Shrager, J. B., Berry, M. F. 2024

  Abstract

  Sublobar resection of early-stage non-small cell lung cancer (NSCLC) is increasingly considered appropriate but may compromise margins compared to lobectomy. This study evaluated resection extent, margin status, and survival for clinical stage I NSCLC patients.Clinical T1-2N0M0 NSCLC patients in the National Cancer Database (2006-2020) treated with primary surgery were compared stratified by margin status. The potential benefit of radiation was explored in subgroup analysis of sublobar resection patients with positive margins.Positive margins occurred in 5,089 (2.8%) of 181,824 patients and were more common in sublobar resections compared to lobectomy (4.3% vs 2.4%,p<0.001). Sublobar resection had the strongest association with positive margins in multivariable analysis (OR 2.06 [95% CI 1.91-2.23],p<0.001). Patients with positive margins were more likely to undergo both adjuvant chemotherapy (16% vs 13%,p<0.001) and radiation (17% vs 1%,p<0.001) but had worse survival in univariate (44.0% 5-year OS vs 69.2%,p<0.001) and multivariable Cox analysis (HR 1.71 [95% CI 1.63-1.78, p<0.001) in the entire cohort, as well as in univariate subset analysis of lobectomy (46.9% vs 70.4%, p<0.001) and sublobar (37.5% vs 64.1%,p<0.001). Postoperative radiation for sublobar patients with positive margins did not improve 5-year OS (36.3% for irradiated patients vs 38.3% for non-irradiated patients,p=0.57), and positive margin sublobar patients treated with radiation had inferior survival to negative margin lobectomy patients.Positive margins occur more frequently after sublobar resection of clinical stage I NSCLC compared to lobectomy. Patients with positive margins have worse survival than complete resection patients and are not rescued by post-operative radiation.

  View details for DOI 10.1016/j.athoracsur.2024.05.032

  View details for PubMedID 38866199

• Four Decades of Progress in Heart-Lung Transplantation: 271 Cases at a Single Institution. The Journal of thoracic and cardiovascular surgery Elde, S., Baccouche, B. M., Mullis, D. M., Leipzig, M. M., Deuse, T., Krishnan, A., Fawad, M., Dale, R., Walsh, S., Padilla-Lopez, A., Wesley, B., He, H., Yajima, S., Zhu, Y., Wang, H., Guenthart, B. A., Shudo, Y., Reitz, B. A., Woo, Y. J. 2024

  Abstract

  OBJECTIVE: The objective of this study is to evaluate survival for combined heart-lung transplant (HLTx) recipients across four decades at a single institution. We aim to summarize our contemporary practice based upon more than 271 HLTx over 40 years.METHODS: Data were collected from a departmental database and the United Network for Organ Sharing (UNOS). Recipients <18y, those undergoing redo HLTx , or triple-organ system transplantation were excluded, leaving 271 patients for analysis. The Pioneering Era was defined by date of transplant between 1981-2000 (N=155), and the Modern Era between 2001-2022 (N=116). Survival analysis was performed using cardinality matching of populations based on donor and recipient age, donor and recipient sex, ischemic time, and sex-matching.RESULTS: Between 1981-2022, 271 HLTx were performed at a single institution. Recipients in the Modern Era were older (42 vs 34y, P<0.001) and had shorter waitlist times (78 vs 234d, P<0.001). Allografts from female donors were more common in the Modern Era (59% vs 39%, P=0.002). In the matched survival analysis, 30-day survival (97% vs 84%, P=0.005), 1-year survival (89% vs 77%, P=0.041), and 10-year survival (53% vs 26%, P=0.012) significantly improved in the Modern Era relative to the Pioneering Era, respectively.CONCLUSIONS: Long-term survival in HLTx is achievable with institutional experience and may continue to improve in the coming decades. Advances in mechanical circulatory support, improved maintenance immunosuppression, and early recognition and management of acute complications such as primary graft dysfunction and acute rejection have dramatically improved the prognosis for HLTx recipients in our contemporary institutional experience.

  View details for DOI 10.1016/j.jtcvs.2024.01.042

  View details for PubMedID 38320627

• Trends in the Use of Exception Status since Implementation of 2018 United Network for Organ Sharing Single-Organ Adult Heart Transplant and Its Relation to Postoperative Survival Outcomes Dale, R., Leipzig, M., Pines, K., Chen, Q., Currie, M. E. LIPPINCOTT WILLIAMS & WILKINS. 2023: S65-S66

  View details for Web of Science ID 001094086300118