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Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation
Yukiharu Sugimura1, Moritz Benjamin Immohr1, Hug Aubin1
1Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany.
Insights
Using marginal donor hearts with impaired left ventricular function (LVF) in heart transplantation leads to longer hospital stays and more infections, but does not affect survival up to one year.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- The global shortage of donor organs necessitates the use of marginal donor hearts, including those with impaired left ventricular function (LVF).
- Orthotopic heart transplantation (oHTX) outcomes are influenced by donor heart quality.
Purpose of the Study:
- To evaluate the clinical outcomes of heart transplant recipients based on donor left ventricular ejection fraction (dLVEF).
- To determine if impaired donor LVF impacts post-transplant survival and morbidity.
Main Methods:
- Retrospective analysis of oHTX patients from September 2010 to June 2020.
- Patients were categorized into two groups: impaired dLVEF (≤50%) and normal dLVEF (>50%).
- Clinical data, including survival, hospital stay duration, and postoperative infections, were compared between groups.
Main Results:
- No significant differences in 30-day, 90-day, or 1-year survival were observed between groups.
- Patients receiving hearts from donors with impaired dLVEF had a statistically longer in-hospital stay (p < 0.05).
- Postoperative infection events were significantly more frequent in the impaired dLVEF group (p = 0.03), independent of other factors.
Conclusions:
- Impaired donor LVF is associated with prolonged post-transplant recovery and increased morbidity.
- Despite increased complications, impaired donor LVF does not significantly impact patient survival up to one year post-transplant.
- Donor and recipient LVEF are statistically independent parameters.
Objectives:
The global shortage of donor organs has urged transplanting units to extend donor selection criteria, for example, impaired left ventricular function (LVF), leading to the use of marginal donor hearts. We retrospectively analyzed our patients after orthotopic heart transplantation (oHTX) with a focus on the clinical outcome depending on donor LVF.
Methods:
Donor reports, intraoperative, echocardiographic, and clinical follow-up data of patients undergoing oHTX at a single-center between September 2010 and June 2020 were retrospectively analyzed. Recipients were divided into two groups based on donor left ventricular ejection fraction (dLVEF): impaired dLVEF (group I; dLVEF ≤ 50%; n = 23) and normal dLVEF group (group N; dLVEF > 50%; n = 137).
Results:
There was no difference in 30-day, 90-day, and 1-year survival. However, the duration of in-hospital stay was statistically longer in group I than in group N (N: 40.9 ± 28.3 days vs. I: 55.9 ± 39.4 days, p < 0.05). Furthermore, postoperative infection events were significantly more frequent in group I (p = 0.03), which was also supported by multivariate analysis (p = 0.03; odds ratio: 2.96; confidence interval: 1.12-7.83). Upon correlation analysis, dLVEF and recipient LVEF prove as statistically independent (r = 0.12, p = 0.17).
Conclusions:
Impaired dLVEF is associated with prolonged posttransplant recovery and slightly increased morbidity but has no significant impact on survival up to 1 year posttransplant.
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