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Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United
R A Sorabella1, L Guglielmetti1, A Kantor1
1Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Insights
Older donor age and longer graft ischemic times increase heart transplant recipient risk. Conversely, male donors and the use of antihypertensive agents or insulin show protective effects on 1-year outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Addressing donor heart shortages necessitates evaluating expanded donor criteria.
- The United Network for Organ Sharing (UNOS) database offers insights into donor characteristics and recipient outcomes.
Purpose of the Study:
- To assess the impact of cardiac donor characteristics on post-heart transplantation recipient survival.
- Identify specific donor factors influencing 1-year recipient outcomes.
Main Methods:
- Retrospective analysis of adult heart transplant recipients (2004-2012) from the UNOS STAR database.
- Stratification into survivors (n=13,643) and non-survivors/retransplanted (n=1785) at 1 year.
- Multivariable logistic regression analysis of 33 donor variables to predict 1-year mortality or retransplantation.
Main Results:
- Overall 1-year survival was 88.4%.
- Donor age >40 years, graft ischemic time >3 hours, and specific cardioplegia solutions (Celsior) predicted adverse outcomes.
- Male donor sex, antihypertensive agents, and insulin administration were associated with improved 1-year survival.
Conclusions:
- Donor age, graft ischemic time, and preservation solution impact short-term heart transplant success.
- Donor management strategies involving antihypertensives and insulin may offer protective benefits for recipients.
Introduction:
To address the shortage of donor hearts for transplantation, there is significant interest in liberalizing donor acceptance criteria. Therefore, the aim of this study was to evaluate cardiac donor characteristics from the United Network for Organ Sharing (UNOS) database to determine their impact on posttransplantation recipient outcomes.
Methods:
Adult (≥18 years) patients undergoing heart transplantation from July 1, 2004, to December 31, 2012, in the UNOS Standard Transplant Analysis and Research (STAR) database were reviewed. Patients were stratified by 1-year posttransplantation status; survivors (group S, n = 13,643) and patients who died or underwent cardiac retransplantation at 1-year follow-up (group NS/R = 1785). Thirty-three specific donor variables were collected for each recipient, and independent donor predictors of recipient death or retransplantation at 1 year were determined using multivariable logistic regression analysis.
Results:
Overall 1-year survival for the entire cohort was 88.4%. Mean donor age was 31.5 ± 11.9 years, and 72% were male. On multivariable logistic regression analysis, donor age >40 years (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.27 to 1.64), graft ischemic time >3 hours (OR 1.32, 1.16 to 1.51), and the use of cardioplegia (OR 1.17, 1.01 to 1.35) or Celsior (OR 1.21, 1.06 to 1.38) preservative solution were significant predictors of recipient death or retransplantation at 1 year posttransplantation. Male donor sex (OR 0.83, 0.74 to 0.93) and the use of antihypertensive agents (OR 0.88, 0.77 to 1.00) or insulin (OR 0.84, 0.76 to 0.94) were protective from adverse outcomes at 1 year.
Conclusions:
These data suggest that donors who are older, female, or have a long projected ischemic time pose greater risk to heart transplant recipients in the short term. Additionally, certain components of donor management protocols, including antihypertensive and insulin administration, may be protective to recipients.
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