Long-Term Outcome of Homograft Implants Related to Donor and Tissue Characteristics

Cardiovascular homografts are used for right ventricular outflow tract reconstruction. The procedure has excellent survival rates, but many homografts degenerate and require reintervention. Studies analyzing risk factors for reintervention most often focus on recipient and homograft characteristics, with identification of risk factors such as young recipient age and the use of aortic homografts. This study focuses on less known variables, including donor characteristics and homograft management and its effect on long-term outcome of homograft implantation.

A retrospective study was conducted of 304 patients undergoing right ventricular outflow tract reconstruction at University Hospital Lund, Sweden, between 1995 and 2008. Follow-up was up to 22 years. Donor, homograft, and recipient characteristics were analyzed. Statistical analyses included the Kaplan-Meier method with log-rank test and Cox proportional hazard regression.

Follow-up was 98% complete. There were 12 deaths, and 115 reinterventions were required. Younger donor age was identified as a risk factor. Homografts from multiorgan donors with no ischemic time produced the longest homograft survival. In non-heart-beating donors, long-term results did not differ between 1 and 24 hours of ischemic time and more than 24 hours of ischemic time. Longer retrieval to cryopreservation times seemed to be better compared with shorter time intervals. Long-term outcome was superior in homografts from middle-aged donors.

The best long-term outcome was found when homografts were retrieved from organ donors and middle-aged donors. There is no harm extending the ischemic time in non-heart-beating donors to 48 hours to increase the number of possible donors.