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Heart transplantation from donors with left ventricular ejection fraction under forty percent
Vitalii Poptsov1, Valery Khatutskiy1, Anastasiia Skokova1
1Schumakov National Medical Research Center, Moscow, Russia.
Insights
Using donor hearts with reduced ejection fraction for heart transplantation (HTx) can expand the donor pool. These hearts showed good recovery of systolic function in recipients, especially those needing urgent HTx.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Surgery
Background:
- Heart transplantation (HTx) is the primary treatment for end-stage heart failure.
- The Shumakov National Medical Research Center initiated HTx using donors with left ventricular ejection fraction (LVEF) <40% in 2016.
- This study evaluates outcomes of HTx from donors with impaired left ventricular systolic function.
Purpose of the Study:
- To assess early and late outcomes in heart transplant recipients receiving allografts from donors with abnormal left ventricular systolic function.
- To determine the feasibility of utilizing donor hearts with reduced ejection fraction.
- To identify optimal recipient candidates for such allografts.
Main Methods:
- Retrospective analysis of 487 HTx procedures performed between January 2016 and December 2018.
- Identification of 27 cases (5.5%) involving allografts from donors with LVEF <40%.
- Evaluation of donor characteristics and recipient outcomes, including graft function and survival.
Main Results:
- 47 donors with LVEF <40% were assessed; most had LVEF between 30% and 40%.
- Twenty-five recipients required urgent HTx.
- All surviving recipients showed recovery of systolic function (LVEF >60%), with 85.2% early and 14.8% delayed recovery.
Conclusions:
- Utilizing donor hearts with impaired systolic function is a viable strategy to increase the donor organ pool.
- Such organs are best allocated to recipients requiring urgent HTx, particularly those supported by mechanical circulatory support.
- This approach can mitigate risks associated with early graft dysfunction post-transplantation.
Background:
Heart transplantation (HTx) remains the treatment of choice for patients with end-stage advanced heart failure. In 2016, the Shumakov National Medical Research Center commenced performing HTx from donors with abnormal left ventricular systolic function (LVEF < 40%). The aim of this study was to evaluate early and late outcomes of recipients after HTx from donors with abnormal LV systolic function.
Methods:
Four hundred eighty seven patients underwent HTx in our institution from January 2016 to December 2018. 27 (5.5%) patients were transplanted using cardiac allografts from donors with LVEF <40%.
Results:
A total of 47 donors with LVEF <40% were evaluated for potential donation. Most heart donors revealed a left ventricular ejection fraction ranging between 30% and 40%. Twenty-five recipients required urgent HTx. Four recipients presented with early allograft dysfunction. All surviving recipients demonstrated early (85.2%) or delayed (14.8%) recovery of systolic function (LVEF > 60%).
Conclusion:
The use of dysfunctional donor hearts with impaired LV systolic function may be a realistic approach for expanding the donor pool. However, organs from such donors should be used for recipient cohorts requiring an urgent HTx, particularly for those with pretransplant mechanical circulatory support allowing for hemodynamic support in cases of early graft dysfunction in the post-transplant period.
