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Increased sensitivity to ischemic interval of donor hearts with diminished left ventricular function
Allison B Davila1, Wendy Shih2, Liset N Stoletniy3
1Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, California.
Insights
Carefully selected donor hearts (DHs) with reduced ejection fraction (EF) can achieve long-term survival. Limiting ischemic time is crucial for DHs with diminished left ventricular function, especially those with the lowest EF.
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.
Background:
Previous studies have demonstrated that carefully selected donor hearts (DHs) with poor left ventricular ejection fraction (EF) may be transplanted with long-term survival equivalent to hearts with normal function. The purpose of this study is to facilitate their selection.
Methods:
Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Regression models were developed to estimate hazard ratios with 95% confidence intervals of post-transplant 1-year mortality and failure of EF to recover at 1 year for DHs with EF ≥50%, EF 40%-49.9%, and EF 30%-30.9%.
Results:
During the study period, 31,979 DHs were transplanted. Compared with DHs with left ventricular ejection fraction ≥50%, DHs with reduced EF were younger and had slightly lower body mass index. There were no differences in the mechanism of death between groups and no differences in recipient characteristics, except for a higher incidence of African American recipients of hearts with an EF of 40%-49.9%. Of the variables analyzed, only a 1-hour increase in ischemia time had different hazard ratios for 1-year mortality between groups, with increasing hazard as EF diminished. It was also the only variable that predicted failure of recovery of normal EF and that was in the lowest EF group.
Conclusions:
The impact of DH traits associated with adverse outcomes after heart transplantation that we studied are similar between DHs with EF <50% and those with EF ≥50%. However, limiting ischemic time may be even more important for DHs with diminished left ventricular function, particularly at the low end of the EF spectrum.
