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A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
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A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death

Published on: June 6, 2025

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Improved long-term outcomes after heart transplantation utilizing donors with a traumatic mode of brain death

Eilon Ram1,2,3, Jacob Lavee4,5, Dov Freimark4,5

  • 1Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. eilon.ram@sheba.health.gov.il.

Journal of Cardiothoracic Surgery
|July 24, 2019
PubMed

Insights

Heart transplantation outcomes are significantly better when donors experience traumatic brain death (TBD) versus non-traumatic brain death (NTBD). TBD hearts are linked to lower mortality, reduced rejection rates, and decreased cardiac allograft vasculopathy in recipients.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Immunology

Background:

  • Donor brain death (BD) can impair heart function and hemodynamics, influencing heart transplant (HTx) recipient prognosis.
  • The mechanism of donor BD (traumatic vs. non-traumatic) may affect post-transplant outcomes.

Purpose of the Study:

  • To investigate the impact of the donor's mode of brain death (BD) on heart transplantation (HTx) recipient outcomes.
  • To compare survival rates, rejection incidence, and cardiac allograft vasculopathy (CAV) between recipients of hearts from traumatic BD (TBD) and non-traumatic BD (NTBD) donors.

Main Methods:

  • Retrospective analysis of heart transplant recipients from 1996 to 2017.
  • Categorization of donors based on BD mechanism: traumatic BD (TBD) and non-traumatic BD (NTBD).
  • Kaplan-Meier survival analysis and multivariate regression models were used to assess outcomes.

Main Results:

  • Recipients of TBD hearts (n=105) showed significantly higher 10-year survival (58.1% vs. 37.6%, p=0.044) compared to NTBD hearts (n=85).
  • TBD was independently associated with a 43% reduction in mortality (p=0.033) and a 42% reduction in CAV (p=0.022).
  • Lower rejection rates and significantly higher freedom from CAV were observed in the TBD group.

Conclusions:

  • The mode of donor brain death significantly influences heart transplantation outcomes.
  • Traumatic brain death in donors is associated with improved long-term survival, reduced graft rejection, and a lower incidence of cardiac allograft vasculopathy in recipients.
Abstract

Keywords:
DonorHeart transplantationMode of brain deathRecipient

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