Study cohort
The Scientific Registry of Transplant Recipients (SRTR) was utilized to obtain data on all adult patients (≥18 years) undergoing OHT in the United States between January 1, 2013 and October 17, 2018. Recipients were followed until April 1, 2020. Patients undergoing concomitant OHT with another organ (e.g. heart-liver, heart-lung, heart-kidney etc.) were excluded. Additionally, we excluded all recipients who underwent OHT at centers performing less than 10 total OHTs during the study period. The following characteristics were used to identify ECDs: donor age ≥40 years, left ventricular ejection fraction (LVEF) <60%, distance from transplant center ≥500 miles, hepatitis B (HBV), hepatitis C (HCV) or human immunodeficiency virus (HIV) positive, and donors with ≥50 offers prior to acceptance.