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Published on: June 6, 2025
Donor predictors of allograft use and recipient outcomes after heart transplantation
Kiran K Khush1, Rebecca Menza, John Nguyen
1Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. kiran@stanford.edu
Insights
Many donor factors predict heart allograft nonuse, but these rarely impact recipient outcomes after transplantation. This suggests a need for more liberal use of cardiac allografts, even with relative contraindications.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- National organ donor shortage impacts patients with end-stage heart disease.
- Low acceptance rates of donor hearts for transplantation are a significant issue.
- Identifying predictors of allograft nonuse is crucial for improving heart transplantation rates.
Purpose of the Study:
- Identify donor predictors associated with heart allograft nonuse.
- Determine if these predictors affect recipient post-transplant outcomes.
- Evaluate the impact of donor characteristics on heart transplant success.
Main Methods:
- Retrospective cohort study of 1872 potential organ donors (2001-2008).
- Analysis of donor characteristics and allograft acceptance for heart transplantation.
- Assessment of recipient outcomes based on donor predictors.
Main Results:
- 45% of available allografts were accepted for heart transplantation.
- Donor predictors of nonuse include age >50, female sex, cerebrovascular accident, hypertension, diabetes, troponin assay, left-ventricular dysfunction, and hypertrophy.
- Donor diabetes mellitus predicted increased recipient mortality; donor cause of death predicted prolonged hospitalization.
Conclusions:
- Numerous donor factors predict allograft discard but have minimal impact on recipient outcomes.
- Current criteria for donor heart acceptance may be overly restrictive.
- More liberal use of cardiac allografts, even with relative contraindications, may be warranted to address donor shortages.
Background:
Despite a national organ-donor shortage and a growing population of patients with end-stage heart disease, the acceptance rate of donor hearts for transplantation is low. We sought to identify donor predictors of allograft nonuse, and to determine whether these predictors are in fact associated with adverse recipient post-transplant outcomes.
Methods And Results:
We studied a cohort of 1872 potential organ donors managed by the California Transplant Donor Network from 2001 to 2008. Forty-five percent of available allografts were accepted for heart transplantation. Donor predictors of allograft nonuse included age >50 years, female sex, death attributable to cerebrovascular accident, hypertension, diabetes mellitus, a positive troponin assay, left-ventricular dysfunction and regional wall motion abnormalities, and left-ventricular hypertrophy. For hearts that were transplanted, only donor cause of death was associated with prolonged recipient hospitalization post-transplant, and only donor diabetes mellitus was predictive of increased recipient mortality.
Conclusions:
Whereas there are many donor predictors of allograft discard in the current era, these characteristics seem to have little effect on recipient outcomes when the hearts are transplanted. Our results suggest that more liberal use of cardiac allografts with relative contraindications may be warranted.
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