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Interaction between donor obesity and prolonged donor ischemic time in heart transplantation
Samuel T Kim1, Mark R Helmers2, Amit Iyengar2
1David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Insights
Donor obesity may improve heart transplant outcomes when organ ischemic times are prolonged. Obese donor hearts showed better 30-day mortality and 5-year survival in these cases, suggesting a protective effect.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Donor obesity is a growing concern in organ transplantation.
- The impact of donor obesity on heart transplant outcomes, particularly concerning organ ischemic times, requires further investigation.
Purpose of the Study:
- To determine the impact of donor obesity on heart transplant outcomes.
- To analyze outcomes based on routine (<4 hours) and prolonged (≥4 hours) organ ischemic times.
Main Methods:
- Retrospective analysis of the United Network for Organ Sharing Database (2000-2020).
- Inclusion of adult heart transplant recipients and donors.
- Nearest-neighbor propensity score matching to control for donor obesity.
- Kaplan-Meier survival estimates to assess 5-year survival.
Main Results:
- Analysis included 43,304 heart transplant recipients; 36.8% received organs from obese donors.
- No significant difference in 30-day mortality or 5-year survival between obese and non-obese donor hearts with routine ischemic times.
- With prolonged ischemic times, obese donor hearts were associated with lower 30-day mortality (5.1% vs 6.7%) and improved 5-year survival (74.9% vs 71.2%) compared to non-obese donor hearts.
Conclusions:
- Recipients of obese donor hearts demonstrated improved outcomes when organ ischemic times exceeded 4 hours.
- Donor obesity may attenuate the negative effects of prolonged organ ischemia in heart transplantation.
Background:
The purpose of the study was to determine the impact of donor obesity on outcomes following heart transplantation in the setting of routine (<4 h) and prolonged (≥4 h) organ ischemic times.
Methods:
Retrospective review of the 2000-2020 United Network for Organ Sharing Database was performed to identify adult heart transplant recipients and donors. Nearest-neighbor propensity score matching by donor obesity was performed separately among routine and prolonged cohorts, with Kaplan-Meier survival estimates used to assess survival at 5 years following transplantation.
Results:
A total of 43,304 heart transplant recipients were included in analysis, with 15,925 (36.8 %) receiving obese donor hearts. After propensity-score matching, 30-day mortality and 5-year survival following transplantation were not statistically different between recipients of obese and non-obese donor hearts when organ ischemic times were routine. In the setting of prolonged organ ischemic times, those receiving obese donor hearts experienced lower 30-day mortality (5.1 % vs 6.7 %, p = 0.04) and improved 5-year survival (74.9 % vs 71.2 %, p < 0.01) compared to non-obese donor hearts.
Conclusions:
Recipients of obese donor hearts experienced improved outcomes compared to those receiving non-obese donor hearts when organ ischemic times exceeded 4 h. These findings suggest that the detrimental impact of prolonged organ ischemic time may be attenuated by donor obesity.
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