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Temporal changes in left ventricular systolic function in heart donors: results of serial echocardiography
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
Intensive donor management improved left ventricular systolic function in many potential heart donors with reduced ejection fraction. This pilot study suggests better donor heart function can be achieved, potentially increasing transplant availability.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Limited heart donor availability restricts cardiac transplantation.
- Many donor hearts are unsuitable due to left ventricular dysfunction.
- Optimizing donor management may improve organ viability.
Purpose of the Study:
- To evaluate the impact of intensive donor management on left ventricular systolic function.
- To assess changes in ejection fraction using serial echocardiography.
- To determine if donor heart function can be improved prior to transplantation.
Main Methods:
- Retrospective analysis of the California Transplant Donor Network Database (1996-2000).
- Included donors with initial ejection fraction <50% or wall-motion abnormalities.
- Compared serial echocardiogram ejection fractions using the Wilcoxon signed rank test.
Main Results:
- 13 of 16 subjects had initial ejection fractions <50%.
- Ejection fraction improved in 12 subjects after intensive management.
- 12 donor hearts were transplanted with a 92% recipient survival rate at 16 months.
Conclusions:
- Intensive donor management can improve donor left ventricular function in select cases.
- Further prospective studies are needed to identify predictors of improved function and recipient outcomes.
- This approach may increase the pool of transplantable donor hearts.
Background:
Heart donor availability continues to limit cardiac transplantation rates and many donor hearts are not transplanted because of left ventricular dysfunction. The aim of this study was to determine whether intensive donor management results in improved left ventricular systolic function as measured by serial echocardiography.
Methods:
Using the California Transplant Donor Network Database, all donors who underwent serial echocardiography during donor management (from 1996 to 2000) were identified. The study includes those donors with ejection fractions <50% or regional wall-motion abnormalities shown on the initial echocardiogram. The database provides clinical data describing donor characteristics, treatments, and recipient outcomes. The mean ejection fractions at the first and second echocardiograms were compared using the Wilcoxon signed rank test.
Results:
In 13 of 16 subjects, initial ejection fractions were <50% and improved in 12 subjects after intensive donor management. Seventy-five percent of the donors received high-dose corticosteroids, 15 of 16 received dopamine, and none received thyroid hormone. In 12 subjects, the donor hearts were transplanted with a survival rate of 92% at an average follow-up of 16 months.
Conclusions:
This pilot study indicates that in some cases, intensive donor management is associated with improved donor left ventricular function. Prospective studies are indicated to determine the predictors of improved donor left ventricular dysfunction and of recipient survival when sub-optimal hearts are transplanted.