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The impact of left ventricular dysfunction on cardiac donor transplant rates
Jonathan G Zaroff1, Wayne D Babcock, Stephen C Shiboski
1Department of Medicine, University of California, San Francisco California 94143-0124, USA. zaroff@medicine.ucsf.edu
Insights
Left ventricular dysfunction significantly reduces the use of donor hearts. Improving screening requires addressing this common cardiac issue to increase heart transplants.
Area of Science:
- Cardiology
- Transplant Surgery
- Public Health
Background:
- Donor heart shortages necessitate optimizing donor screening.
- Left ventricular (LV) systolic dysfunction is a key factor impacting donor heart utilization.
Purpose of the Study:
- To quantify the impact of LV systolic dysfunction on the use of donor hearts.
- To identify cardiac causes of donor heart non-utilization.
Main Methods:
- Analysis of 223 potential heart donors from the California Transplant Donor Network database (1997-1998).
- Exclusion criteria included inability to obtain consent and age extremes (13-59 years).
- Logistic regression used to determine the independent effect of LV dysfunction on donor heart use.
Main Results:
- 44% of potential donor hearts were not transplanted.
- Cardiac causes accounted for 36 non-transplanted hearts, with LV dysfunction (26) and coronary artery disease (8) being primary.
- Reduced ejection fraction was the strongest predictor of non-use (OR 1.48 per 5-point decrease).
Conclusions:
- LV dysfunction is a major reason for failing to transplant adult donor hearts.
- Strategies to enhance donor heart yield should prioritize preventing or reversing LV dysfunction.
Background:
Because of the shortage of heart donors in the United States, efforts are necessary to maximize the yield of donor screening. The purpose of this study was to quantify the effects of left ventricular (LV) systolic dysfunction on heart donor use.
Methods:
Using the California Transplant Donor Network database, the records of all potential organ donors screened between January 1997 and June 1998 were reviewed. After excluding subjects for whom family consent could not be obtained and subjects <13 or >or=60 years old, a study group of 223 potential heart donors was analyzed. The number of hearts not used because of LV dysfunction, coronary artery disease (CAD), valvular disease, and LV hypertrophy were quantified. A logistic regression model was developed to quantify the independent effect of LV dysfunction on donor use rates after adjustment for age, weight, and cause of death.
Results:
Ninety-nine (44%) of the 223 potential donor hearts were not transplanted. Thirty-six of these hearts were not transplanted because of cardiac causes, primarily LV dysfunction (26 cases) and CAD (8 cases). The multivariable analysis showed that after adjusting for other donor variables, ejection fraction was the most significant predictor of non-use, with an odds ratio of 1.48 per 5-point decrease in ejection fraction.
Conclusions:
Left ventricular dysfunction is an important cause of failure to transplant adult donor hearts. Efforts to improve the yield of heart donor screening should focus on prevention or reversal of LV dysfunction.