Impact of donor comorbidities on heart transplant outcomes in the modern era

Area of Science:

• Cardiology
• Transplantation Immunology
• Medical Statistics

Background:

• The increasing organ shortage in heart transplantation (HTx) necessitates the use of marginal donors, including those with cardiovascular risk factors.
• This practice remains controversial due to potential impacts on post-transplant outcomes.

Purpose of the Study:

• To investigate the outcomes of heart transplantation (HTx) in the recent era using marginal donor characteristics.
• To compare post-transplant outcomes, including primary graft dysfunction (PGD) and cardiac allograft vasculopathy (CAV), between two time periods with differing donor profiles.

Main Methods:

• A retrospective review of 261 heart transplants (HTx) performed between January 1996 and March 2013.
• Donor characteristics were analyzed from a national database, comparing recipients of transplants from 1996-2004 (Group A) and 2005-2013 (Group B).
• Outcomes assessed included primary graft dysfunction (PGD), cardiac allograft vasculopathy (CAV), and overall patient survival.

Main Results:

• Donors in the later period (Group B) were older, had higher BMI, and were more likely to be smokers or have hypertension compared to Group A.
• No significant differences were observed in 1-year or 5-year survival rates, PGD incidence, or freedom from CAV at 5 years between the two groups.
• Donor hypertension was identified as the only donor characteristic associated with reduced post-transplant survival.

Conclusions:

• The utilization of older cardiac donors with cardiovascular comorbidities in the recent era does not appear to compromise heart transplant outcomes.
• Donor hypertension emerges as a critical factor, independently linked to poorer survival following heart transplantation.
• These findings support the cautious use of marginal donors in heart transplantation while emphasizing the importance of donor hypertension as a risk factor.