Increased sensitivity to ischemic interval of donor hearts with diminished left ventricular function

Area of Science:

• Cardiology
• Transplantation Medicine
• Organ Donor Selection

Background:

• Previous research indicates that carefully selected donor hearts (DHs) with reduced left ventricular ejection fraction (EF) can yield long-term survival comparable to hearts with normal function.
• This highlights the need for improved selection criteria for DHs with suboptimal EF.

Purpose of the Study:

• To facilitate the selection of donor hearts (DHs) with reduced ejection fraction (EF) for transplantation.
• To identify factors influencing post-transplant outcomes in recipients of DHs with varying EF levels.

Main Methods:

• Analysis of adult heart transplant data from the United Network for Organ Sharing (UNOS) database (January 2000 - March 2016).
• Development of regression models to assess 1-year mortality and EF recovery failure in DHs stratified by EF (≥50%, 40%-49.9%, 30%-39.9%).

Main Results:

• 31,979 DHs were transplanted during the study period.
• DHs with reduced EF were younger with lower BMI; no significant differences in death mechanisms or recipient characteristics, except for higher incidence of African American recipients in the 40%-49.9% EF group.
• Increased ischemia time was the sole variable predicting higher 1-year mortality and failure to recover normal EF, particularly in the lowest EF group.

Conclusions:

• The impact of donor heart traits on adverse outcomes is similar between DHs with EF <50% and EF ≥50%.
• Minimizing ischemic time is critically important for DHs with diminished left ventricular function, especially those with the lowest EF.