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Published on: September 28, 2022
Impact of Donor Origin on Survival After Orthotopic Heart Transplantation
Omid Kiamanesh1, Amit Khosla2, Erica Johansson2
1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Heart transplantation outcomes are similar regardless of donor origin. Distant organ donors, even with longer ischemic times, do not negatively impact patient survival after heart transplants in British Columbia.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- End-stage heart failure necessitates heart transplantation.
- Organ donor shortages lead to the use of distant organs.
- Concerns exist regarding the quality of distant donor organs due to risk factors and ischemic times.
Purpose of the Study:
- To compare survival rates after heart transplantation based on donor origin (British Columbia, other Canadian provinces, United States).
- To investigate if donor location influences post-transplant mortality.
- To assess the impact of ischemic time on heart transplant outcomes.
Main Methods:
- Retrospective cohort analysis of heart transplant recipients in British Columbia (December 1, 1988 - October 21, 2014).
- Inclusion of 382 patients, excluding retransplantations and those with missing data.
- Comparison of 10-year survival rates across different donor geographic origins, controlling for recipient and donor age, and cold ischemic time.
Main Results:
- Overall 10-year survival was 62.1%.
- No significant difference in 10-year survival was observed between donors from British Columbia, other Canadian provinces, and the United States.
- Donor location did not predict mortality, even with longer ischemic times for non-local donors.
Conclusions:
- Donor origin does not impact long-term survival after heart transplantation in British Columbia.
- Distant organ donors can yield similar outcomes to local donors, despite potentially longer ischemic times.
- These findings support the use of a wider donor pool to improve access to heart transplantation.
Abstract:
Heart transplantation is the definitive management for select patients with end-stage heart failure. Owing to an ongoing organ donor shortage, organs are sometimes allocated from distant locales. These organs may be perceived as less desirable because of donor risk factors and ischemic times. We compared survival after heart transplantation by donors originating from British Columbia (BC), other Canadian provinces, and the United States. This retrospective cohort analysis included all patients transplanted in BC between December 1, 1988, and October 21, 2014, and excluded those with missing data or retransplantation. Among 382 patients, 297 (77.7%) recipients and 238 (62.3%) donors were male. The median recipient age was 54.6 years (interquartile range, 46.0-61.0 years) and the median donor age was 33 years (interquartile range, 22-46 years). Overall 10-year survival was 62.1% (95% confidence interval, 56.3-67.4). There was no difference in 10-year survival when comparing donors from BC, other Canadian provinces, and the United States despite significantly lower median ischemic times in donors from BC. Donor location was not predictive of mortality after controlling for recipient age, donor age, and cold ischemic time. Donor origin did not impact 10-year survival after heart transplantation despite increased ischemic time, suggesting that distant donors result in similar outcomes in BC.
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