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Outcomes After Transplantation of Donor Hearts With Improving Left Ventricular Systolic Dysfunction
Shivank Madan1, Omar Saeed1, Peter Vlismas2
1Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Insights
Donor hearts with transient left ventricular systolic dysfunction (LVSD) can be successfully transplanted. This study found no increased risk of recipient mortality, graft failure, or cardiac allograft vasculopathy in recipients of these hearts.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Left ventricular systolic dysfunction (LVSD) is a common reason for donor heart nonacceptance, affecting nearly 25% of potential donors.
- Previous studies suggest LVSD in brain-dead donors may be transient and reversible with appropriate management.
- Successful resuscitation and transplantation of hearts with resolved LVSD could expand the donor pool.
Purpose of the Study:
- To evaluate the outcomes of donor hearts with initial LVSD that resolved during donor management.
- To compare the long-term survival and graft function of recipients receiving hearts with improved LVSD versus those with initially normal function.
Main Methods:
- A retrospective analysis of the United Network of Organ Sharing database (2007-2015) identified 472 donor hearts with LVSD (LVEF ≤40%) that resolved (LVEF ≥50%) before transplantation.
- These hearts were compared to donor hearts with initially normal LVEF (≥55%).
- Outcomes assessed included recipient mortality, primary graft failure (PGF), and cardiac allograft vasculopathy (CAV). Propensity score matching was used for robust comparison.
Main Results:
- No significant differences were observed in 30-day, 1-year, 3-year, or 5-year recipient mortality between the improved LVSD group and the initially normal LVEF group.
- Rates of PGF at 90 days and CAV at 5 years were also similar between the two groups.
- Post-transplant length of stay and outcomes after propensity score matching further supported the safety and efficacy of transplanting hearts with resolved LVSD.
Conclusions:
- Transient LVSD in donor hearts does not appear to compromise long-term recipient survival or graft health.
- This study, the largest of its kind, supports the successful resuscitation and transplantation of hearts with resolved LVSD.
- Optimizing donor management is crucial and can increase the utilization of donor hearts that might otherwise be discarded due to temporary LVSD.
Background:
Left ventricular systolic dysfunction (LVSD) accounts for almost 25% of nonacceptance of potential donor hearts. Previous smaller, single-center studies showed that LVSD following brain death may be transient, and such hearts can be successfully resuscitated with resolution of LVSD, then transplanted.
Objectives:
This study evaluated outcomes of donor hearts with LVSD on initial transthoracic echocardiogram (TTE) that resolved during donor management.
Methods:
We reviewed echocardiograms of all cardiac donors in the United Network of Organ Sharing database that were transplanted from January 1, 2007, to September 30, 2015, and identified 472 donor hearts with LVSD (left ventricular ejection fraction [LVEF] ≤40%) on initial TTE that resolved (LVEF ≥50%) during donor management on a subsequent TTE. These patients comprised the improved donor LVEF group. These were compared with donor hearts with normal LVEF (LVEF ≥55%) on the initial TTE for recipient mortality, cardiac allograft vasculopathy (CAV), and primary graft failure (PGF).
Results:
There was no significant difference in recipient mortality at 30 days, 1 year, 3 years, and 5 years of follow-up, nor any difference in rates of PGF at 90 days and CAV at 5 years between recipients of donor hearts with improved LVEF and recipients of donor hearts with initially normal LVEF. Post-transplant length of stay was also similar between the 2 groups. Using propensity scores, 461 transplants in the improved-donor LVEF group were matched to 461 transplants in the normal-donor LVEF group. There was no significant difference in PGF at 90 days or recipient mortality after up to 5 years of follow-up.
Conclusions:
In the largest analysis of donor hearts with transient LVSD, we found that such hearts can be successfully resuscitated and transplanted without increasing recipient mortality, CAV, or PGF. These results underscore the importance of appropriate donor management and should help to increase utilization of donor hearts with transient LVSD.
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