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Are non-brain stem-dead cardiac donors acceptable donors?
Heyman Luckraz1, Susan C Charman, Jayan Parameshwar
1Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, UK.
Summary
Domino donor hearts show similar outcomes to brainstem-dead donor hearts in heart transplantation. This suggests potential endothelial cell activation in domino donors, despite avoiding brainstem death effects.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Biology
Background:
- Brainstem death (BSD) negatively impacts donor heart function and endothelial integrity.
- Domino cardiac donation, using hearts from heart-lung recipients, bypasses BSD effects and may benefit recipients.
Purpose of the Study:
- To compare short- and long-term outcomes of heart transplantation using domino donor hearts versus standard brainstem-dead (BSD) donor hearts.
Main Methods:
- Retrospective analysis of 571 cardiac transplant recipients (April 1989-August 2001).
- Comparison of outcomes between 81 domino donor heart recipients and BSD donor heart recipients.
- Evaluation of mortality, survival rates, acute rejection, infection, and cardiac allograft vasculopathy (CAV).
Main Results:
- No significant differences in 30-day mortality or actuarial survival between domino and BSD groups.
- Domino group had significantly shorter ischemic times.
- Similar rates of acute rejection and infection episodes in both groups.
- 5-year survival: 78% (domino) vs. 69% (BSD); 2-year freedom from CAV: 96% (domino) vs. 93% (BSD).
Conclusions:
- Domino donor hearts perform similarly to BSD donor hearts despite shorter ischemic times and lack of pre-transplant endothelial activation.
- This suggests potential endothelial cell activation in domino donors, similar to BSD donors.
- Domino donation is a viable option with comparable outcomes to standard donation.