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Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit
Olimpia Bifulco1, Tomaso Bottio1, Raphael Caraffa1
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy.
Insights
Using marginal donors (MDs) for heart transplantation (HTx) expands the donor pool. While overall survival is lower than with standard donors (SDs), selected MDs offer promising mid-term outcomes, especially when considering risk-adjusted mortality.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donor Research
Background:
- Assessing mid-term outcomes of heart transplantation (HTx) using marginal donors (MDs).
- Comparing outcomes between MD and standard donor (SD) recipients.
Purpose of the Study:
- Evaluate the efficacy and safety of utilizing marginal donor hearts.
- Identify risk factors for graft failure and mortality in MD recipients.
- Compare survival rates between MD and SD recipients.
Main Methods:
- Retrospective analysis of 238 HTx patients (January 2012 - December 2020).
- Primary endpoints: early and long-term survival of MD recipients.
- Secondary endpoint: comparison of MD versus SD recipient survival.
- Multivariate analysis for risk factors of primary graft failure (PGF) and mortality.
Main Results:
- 64 (26.9%) patients received organs from MDs.
- MD recipients showed 1-year survival of 70% and 5-year survival of 68.1%.
- Risk factors for mortality in MD recipients included decreased renal function and increased inotropic support.
- Increased cold ischemic time and donor inotropic support were independent risk factors for PGF.
- Overall 5-year survival was higher in SD recipients (85%) than MD recipients (68.1%).
- Risk-adjusted mortality and 5-year conditional survival were comparable between groups.
Conclusions:
- Selected marginal donors are a valuable resource for expanding the cardiac donor pool.
- Utilizing marginal donors demonstrates promising mid-term results.
- Prolonged ischemic times, increased inotropic support (donor or recipient), and decreased renal function are associated with worse outcomes in MD recipients.
Background:
In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD).
Methods:
All patients who underwent HTx between January 2012 and December 2020 were enrolled at a single institution. The primary endpoints were early and long-term survival of MD recipients. Risk factors for primary graft failure (PGF) and mortality in MD recipients were also analyzed. The secondary endpoint was the comparison of survival of MD versus SD recipients.
Results:
In total, 238 patients underwent HTx, 64 (26.9%) of whom received an organ from an MD. Hospital mortality in the MD recipient cohort was 23%, with an estimated 1 and 5-year survival of 70% (59.2-82.7) and 68.1% (57.1-81), respectively. A multivariate analysis in MD recipients showed that decreased renal function and increased inotropic support of recipients were associated with higher mortality (p = 0.04 and p = 0.03). Cold ischemic time (p = 0.03) and increased donor inotropic support (p = 0.04) were independent risk factors for PGF. Overall survival was higher in SD than MD (85% vs. 68% at 5 years, log-rank = 0.008). However, risk-adjusted mortality (p = 0.2) and 5-year conditional survival (log-rank = 0.6) were comparable.
Conclusions:
Selected MDs are a valuable resource for expanding the cardiac donor pool, showing promising results. The use of MDs after prolonged ischemic times, increased inotropic support of the MD or the recipient and decreased renal function are associated with worse outcomes.
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