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Updated: Aug 16, 2026
Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique
Published on: October 12, 2014
Use of hearts transplanted from donors with atraumatic intracranial bleeds
Feng Chun Tsai1, Daniel Marelli, Jessica Bresson
1The University of California, Los Angeles Heart Transplant Program, USA.
Insights
Hearts from donors with atraumatic intracranial bleeds (aICB) pose an increased risk for early mortality in heart transplant recipients. However, long-term survival and transplant coronary artery disease risk were not significantly affected. Careful donor evaluation is crucial.
Area of Science:
- Cardiology
- Transplantation Medicine
- Neurosurgery
Background:
- Donor atraumatic intracranial bleed (aICB) is linked to older age and hypertension.
- Hearts from aICB donors may carry higher risk for graft failure due to catecholamine surge.
- This study investigates the independent impact of aICB donor hearts on transplantation outcomes.
Purpose of the Study:
- To determine if hearts from donors with atraumatic intracranial bleeds (aICB) independently affect heart transplant outcomes.
- To identify risk factors associated with early mortality after heart transplantation.
- To assess the long-term impact of aICB donor hearts on patient survival and transplant coronary artery disease.
Main Methods:
- Retrospective review of adult heart transplant recipients (July 1994-December 1999).
- Exclusion of non-standard hearts (e.g., donor age >55 years).
- Comparison of outcomes between recipients of hearts from donors with aICB (n=80) and without aICB (n=171).
Main Results:
- Donors with aICB were older, more frequently female, and had a higher history of hypertension.
- Early mortality risk was higher for recipients of aICB donor hearts (OR=3.25, p=0.02).
- No significant difference in 5-year actuarial survival (72% vs 81%, p=0.52); however, a trend towards increased transplant coronary artery disease was observed (74% vs 80%, p=0.05).
Conclusions:
- Donor aICB is a potential independent risk factor for early mortality post-heart transplantation.
- Caution is advised when evaluating aICB donors, especially with co-existing risk factors like female gender or depressed ejection fraction.
- Long-term outcomes and transplant coronary artery disease risk may not be significantly impacted by aICB donor hearts.
Background:
Donor atraumatic intracranial bleed (aICB) is associated with older age and may reflect a history of hypertension. Hearts from donors who died of aICB may be at increased risk for graft failure because of the associated catecholamine surge. We evaluated whether receiving a heart from a donor who had an aICB independently affected the outcome of transplantation.
Methods:
We reviewed adult patients (>18 years) who underwent heart transplantation between July 1994 and December 1999. We excluded patients who received non-standard hearts (e.g., donor age >55 years). Group 1 received hearts from donors with aICB (n = 80), and Group 2 received hearts from donors who did not have aICB (n = 171).
Results:
Recipient age, gender, United Network for Organ Sharing status, and indication for transplantation were similar for both groups. Donors in Group 1 were older (41 vs 26 years, p = 0.001), more commonly women (55% vs 20%, p = 0.001), and more often had history of hypertension (26% vs 2%, p = 0.001). Survival to discharge was 86% in Group 1 and 95% in Group 2. Actuarial 5-year survival was 72% for Group 1 and 81% for Group 2 (p = 0.52). Regression analysis showed that receiving a heart from a donor with aICB was a risk factor for early recipient mortality but not for long-term outcome (odds ratio = 3.25, p = 0.02, and hazard ratio = 1.16, p = 0.69, respectively). Donor aICB, female gender, and abnormal initial echocardiogram (global hypokinesia) were selected as clinically relevant independent risk factors for early mortality of the recipient, using a fitted multifactor logistic regression model (goodness-of-fit chi-square p value = 0.94). Donor age, accident-to-retrieval time interval, and borderline left ventricular hypertrophy did not significantly differ. Five-year freedom from transplant coronary artery disease in Group 1 was 74% (vs 80% in Group 2, p = 0.05).
Conclusions:
The trend observed in this series suggests that receiving a heart from a donor with aICB is a potential independent risk factor for early mortality after transplantation independent of age. Caution should be used when evaluating such donors, particularly when other risk factors such as female donor or depressed ejection fraction are present.
