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Published on: August 2, 2024
Impact of donor ventricular function on heart transplantation outcomes
Ahad Firoz1, Roh Yanagida2, Eman Hamad3
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Insights
Donor hearts with reduced ejection fraction are viable for heart transplant (HTx) if ischemic time is short. This finding may expand donor heart eligibility and increase HTx rates.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Heart transplant (HTx) centers face organ shortages, leading to expanded donor eligibility criteria.
- Utilizing donor hearts with ventricular dysfunction is an area of active research.
Purpose of the Study:
- To determine the relationship between donor left ventricular ejection fraction (LVEF) and heart transplant outcomes.
- To investigate the impact of ischemic time and donor age on outcomes when using donors with reduced LVEF.
Main Methods:
- Retrospective analysis of 46,936 adult heart transplant recipients from 1996-2021.
- Donor LVEF categorized as <50%, 50%-70%, and >70%.
- Ischemic time and donor age stratified into multiple groups for analysis.
Main Results:
- Donor LVEF <50% showed a slight increase in overall mortality risk (HR=1.16, p=0.013).
- This increased risk was significant only with prolonged ischemic time (>3.0 hours).
- No significant survival difference was observed with limited ischemic time (≤3.0 hours) or across donor age groups.
Conclusions:
- Heart transplant recipients with low donor ejection fraction have comparable survival to those with normal dLVEF when ischemic time is ≤3.0 hours.
- Reduced donor LVEF is not significantly affected by advanced donor age.
- Findings may encourage the use of more donor hearts, potentially increasing transplant rates.
Background:
Some heart transplant (HTx) centers have expanded their donor eligibility criteria in response to the organ shortage; one area of active interest involves utilizing hearts with ventricular dysfunction. Our study seeks to identify if a relationship exists between donor left ventricular ejection fraction (LVEF) and ischemic time or donor age on HTx outcomes.
Methods:
We performed a retrospective analysis on adult patients who had a HTx between 1996 and 2021 (n = 46,936). Donor LVEF (dLVEF) values were categorized into three groups: <50%, 50%-70%, and >70%. Ischemic time and donor age were stratified into four groups: ≤2.0, 2.1-3.0, 3.1-4.0, >4.0 h, and ≤30, 31-40, 41-50, >50 years, respectively. The outcome of interest was long-term survival.
Results:
Multivariable survival analysis found a slight increase in overall mortality risk for patients with donor ejection fractions <50% (HR = 1.16, p = .013). However, subsequent subgroup investigation discovered that this elevated hazard was only applicable when ischemic time was prolonged to >3.0 h (3.1-4.0 h: HR = 1.23, p = .024; > 4.0 h: HR = 1.52, p < .001). There was no significant difference in survival between dLVEF groups when ischemic time was limited to ≤3.0 h or when stratified by donor age.
Conclusion:
HTx patients with a low donor ejection fraction have comparable survival to recipients with a normal dLVEF when ischemic time is limited to ≤3.0 h. Reduced dLVEF does not appear to be sensitive to advanced donor age. The clinical implications of our study may encourage the recruitment of more donor hearts for transplantation.
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