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Does Donor Cardiopulmonary Resuscitation Time Affect Heart Transplantation Outcomes and Survival?
Allen Cheng1, Erin M Schumer1, Jaimin R Trivedi1
1Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Insights
Donor cardiopulmonary resuscitation (CPR) duration does not significantly impact heart transplant recipient survival or outcomes. This finding suggests that CPR time alone should not disqualify a donor heart, optimizing organ utilization.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Donor Management
Background:
- Limited donor heart availability restricts heart transplant numbers.
- Increasing waitlist deaths necessitate optimizing donor heart utilization.
- Donor cardiopulmonary resuscitation (CPR) time is a debated donor selection criterion.
Purpose of the Study:
- To evaluate the impact of donor CPR duration on heart transplant recipient outcomes.
- To determine if CPR time influences posttransplantation survival rates.
- To inform donor heart acceptance criteria.
Main Methods:
- Retrospective analysis of the United Network of Organ Sharing database (2005-2013).
- Categorization of adult heart transplant recipients based on donor CPR duration (none, <20 min, 20-30 min, >30 min).
- Kaplan-Meier survival analysis, propensity matching, and multivariable logistic regression were employed.
Main Results:
- No significant difference in 1-year or 5-year posttransplant survival across CPR duration groups.
- Similar rates of primary graft failure and rejection among all groups.
- Donor CPR duration was not an independent risk factor for posttransplant mortality.
Conclusions:
- Donor CPR duration does not significantly affect heart transplant recipient outcomes or survival.
- CPR time should not be the sole factor for excluding a potential donor heart.
- Optimizing donor heart utilization can be achieved by reconsidering CPR time as an absolute exclusion criterion.
Background:
Donor heart availability has limited the number of heart transplants performed in the United States, while the number of patients waiting for a transplant continues to increase. Optimizing the use of all available donor hearts is important to reduce waiting list deaths and to increase the number of patients who can ultimately undergo a successful heart transplant. Donor cardiopulmonary resuscitation (CPR) time has been proposed to be a selection criterion to consider in donor selection. This study examined whether the duration of donor CPR time affects recipient posttransplantation outcomes and survival.
Methods:
The United Network of Organ Sharing database was retrospectively queried from January 2005 to December 2013 to identify adult patients who underwent heart transplantation. This population was divided into four groups: donors with no CPR, CPR of less than 20 minutes, CPR of 20 to 30 minutes, and CPR exceeding 30 minutes. Kaplan-Meier analysis was used to compare the recipient posttransplant survival between groups, and posttransplant outcomes were examined. Propensity matching was performed for comparison of posttransplant survival of recipients of donors who did and did not undergo CPR. Multivariable logistic regression analysis was performed to examine individual independent variables for death after transplant.
Results:
During this period, 17,022 patients underwent heart transplantation. Of those, 16,042 patients received hearts from a donor with no CPR, 639 patients with donor CPR of less than 20 minutes, 154 patients with donor CPR 20 to 30 minutes, and 187 patients with donor CPR exceeding 30 minutes. The posttransplant survival at 1 year for each group was 89% vs 90% vs 88% vs 89% and at 5 years was 75% vs 74% vs 74% vs 72%, respectively, which was not significantly different among the groups. Recipient primary graft failure and rejection rates were similar among the groups. The multivariable regression model showed CPR duration was not an independent risk factor for posttransplant death.
Conclusions:
Donor CPR does not significantly affect outcomes and survival after transplant. In an effort to optimize donor heart use, donor CPR time alone should not be used to rule out the acceptance of a potential donor heart.
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