Related Experiment Video
Updated: Oct 12, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Impact of using higher-risk donor hearts for candidates with pre-transplant mechanical circulatory support
Jiho Han1, Yasbanoo Moayedi2, Wenjia Yang1
1Department of Medicine, Stanford University, Stanford, California.
Insights
Using higher-risk donor hearts for heart transplant candidates on temporary mechanical circulatory support (MCS) showed comparable survival. However, stable patients on durable left ventricular assist devices (LVADs) may benefit from waiting for standard-risk donor hearts.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Assessing outcomes of heart transplantation (HTx) using higher-risk donor hearts in patients requiring mechanical circulatory support (MCS) before transplant.
- Evaluating the impact of donor heart quality on post-transplant survival in a vulnerable patient population.
Purpose of the Study:
- To determine if higher-risk donor hearts impact 1-year survival in heart transplant candidates supported by pre-transplant mechanical circulatory support (MCS).
- To compare outcomes between standard-risk and higher-risk donor hearts in different MCS support strategies.
Main Methods:
- Retrospective analysis of 9,915 adult heart transplant recipients from the United Network for Organ Sharing registry (2010-2019).
- Higher-risk donor criteria included LVEF <50%, donor/recipient heart mass ratio <0.86, donor age >55, or ischemic time >4 hours.
- Primary outcome was 1-year post-transplant survival, analyzed across different pre-transplant MCS types (temporary vs. durable).
Main Results:
- Among 3,688 recipients of higher-risk donor hearts, those on temporary MCS (extracorporeal membrane oxygenation or biventricular assist device) had comparable 1-year survival to those receiving standard-risk hearts.
- Heart transplant recipients supported by intra-aortic balloon pumps also showed no adverse effect on 1-year survival with higher-risk donor hearts.
- Patients on durable left ventricular assist devices (LVADs) receiving higher-risk donor hearts had increased mortality compared to those receiving standard-risk hearts.
Conclusions:
- Pre-transplant temporary mechanical circulatory support (MCS) recipients using higher-risk donor hearts demonstrate comparable 1-year survival post-heart transplant.
- Stable patients on durable left ventricular assist devices (LVADs) may experience better outcomes by waiting for standard-risk donor hearts.
Background:
We evaluated post-heart transplant (HTx) outcomes after use of higher-risk donor hearts for candidates supported with pre-HTx mechanical circulatory support (MCS).
Methods:
In this retrospective analysis of the national United Network for Organ Sharing registry, a total of 9,915 adult candidates on MCS underwent HTx from January 1, 2010 to March 31, 2019. Multi-organ, re-transplant, and congenital heart disease patients were excluded. Higher-risk donor organs met at least one of the following criteria: left ventricular ejection fraction <50%, donor to recipient predicted heart mass ratio <0.86, donor age >55 years, or ischemic time >4 hours. Primary outcome was 1 year post-transplant survival.
Results:
Among HTx recipients, 3688 (37.2%) received higher-risk donor hearts. Candidates supported with pre-HTx extracorporeal membrane oxygenation or biventricular assist device (n = 374, 3.8%) who received higher-risk donor hearts had comparable 1 year survival (HR: 1.14, 95% CI: [0.67-1.93], p = 0.64) to recipients of standard-risk donor hearts, when adjusted for recipient age and sex. In candidates supported with intra-aortic balloon pump (n = 1391, 14.6%), transplantation of higher-risk donor hearts did not adversely affect 1 year survival (HR: 0.80, 95% CI: [0.52-1.22], p = 0.30). Patients on durable left ventricular assist devices (LVAD) who received higher-risk donor hearts had comparable 1 year survival to continued LVAD support on the waitlist, but mortality was increased compared to those who received standard-risk donor hearts (HR: 1.37, 95% CI: [1.11-1.70], p = 0.004).
Conclusions:
Patients requiring pre-HTx temporary MCS who received higher-risk donor hearts had comparable 1 year post-transplant survival to those who received standard-risk donor hearts. Stable patients on durable LVADs may benefit from waiting for standard-risk donor hearts.
