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Use of potentially infected donor hearts for cardiac transplantation
D E Lammermeier1, M S Sweeney, H E Haupt
1Division of Cardiovascular Surgery, Texas Heart Institute, Houston.
Insights
Using hearts from donors with infections is safe for critically ill patients needing transplants. This practice, despite risks like positive blood cultures, led to few infectious complications, offering a viable option when donors are scarce.
Area of Science:
- Cardiology
- Transplantation Medicine
- Infectious Diseases
Background:
- Critical shortage of heart donors nationwide.
- Increasing acceptance of critically ill patients for heart transplantation.
- Liberalization of donor criteria to meet transplant demand.
Purpose of the Study:
- To evaluate the safety and outcomes of using potentially infected donor hearts in critically ill recipients.
- To assess infectious complications in recipients of hearts from donors with positive blood cultures, high fevers, or hepatitis B.
Main Methods:
- Retrospective analysis of 16 heart transplant recipients who received organs from potentially infected donors.
- Review of donor infectious markers (blood cultures, fever, sputum, hepatitis B status).
- Monitoring of recipient early (≤30 days) and late (>30 days) mortality and infectious complications.
Main Results:
- Seven donors had positive blood cultures (Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter sp.).
- Seven donors had high fevers, leukocytosis, and pulmonary infiltrates with positive sputa.
- Two donors were hepatitis B surface antigen positive.
- Early mortality was 18.7% (3/16) due to rejection, hepatic failure, and Pseudomonas septicemia.
- Late mortality occurred in 6 patients (hepatic failure, graft atherosclerosis, hemorrhage).
- Surprisingly few infectious complications were observed in recipients related to donor organisms.
Conclusions:
- Transplanting hearts from potentially infected donors can be a safe practice.
- This approach resulted in minimal infectious complications in recipients.
- Liberalizing donor criteria to include high-risk donors should be considered in situations of organ scarcity.
Abstract:
Despite the nationwide shortage of heart donors, more patients, some of whom are critically ill, are being accepted as candidates for transplantation. Thus, on occasion, we have liberalized our donor criteria to meet the demand. We have recently transplanted 16 potentially infected donor hearts into critically ill recipients. Of these 16 donors, 7 had multiple positive blood cultures as follows: Streptococcus pneumoniae (3), Staphylococcus aureus (2), Klebsiella pneumoniae (1), and Enterobacter sp (1). Seven other donors were accepted despite high fevers (rectal temperature greater than 38.9 degrees C), leukocytosis (greater than 18 x 10(9)/L [greater than 18,000 cells/microL]), and pulmonary infiltrates with positive sputa (Enterobacter [3], Klebsiella pneumoniae [2], and Staphylococcus [2]). Two other donors with hepatitis B surface antigen positivity were deemed at high risk but were used because the recipients were in immediate need. Early mortality (less than or equal to 30 days) among the recipients was 3/16 (18.7%) with 1 patient dying of uncontrolled allograft rejection, 1 of hepatic failure, and 1 of Pseudomonas septicemia. Late mortality (greater than 30 days after operation) occurred in 6 patients: 2 patients died of hepatic failure, 3 died of graft atherosclerosis, and 1 died of iatrogenic hemorrhage after a liver biopsy. Only 1 patient died of infection unrelated to that of the donor, and the other patients had no infectious complications resulting from the organisms identified in their respective donors. Use of potentially infected donor hearts resulted in surprisingly few infectious complications in this group of recipients. This practice can be safe and should be considered when other options are unavailable.