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The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience
Soo Yong Lee1, Seok Hyun Kim1, Min Ho Ju2
1Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Insights
Marginal donor (MD) hearts can be safely used in heart transplantation (HTx), especially for low-risk recipients. This study found no significant difference in outcomes between MD and non-MD groups, suggesting MD hearts are a viable option.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Donor heart shortage is a global challenge.
- Marginal donor (MD) hearts are often underutilized.
- Limited research exists on the impact of MD hearts in heart transplantation (HTx).
Purpose of the Study:
- To investigate the clinical impact and prognosis of using marginal donor (MD) hearts in heart transplantation (HTx).
- To assess the outcomes of HTx utilizing MD hearts compared to standard donor hearts.
Main Methods:
- Analysis of 73 consecutive HTx procedures between 2014 and 2021.
- MD definition: donor age >55, LVEF <50%, CIT >240 min, or structural issues.
- Risk stratification using the Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score.
Main Results:
- 32 (43.8%) patients received organs from MDs.
- No significant differences in primary graft dysfunction (PGD), 30-day, or long-term survival between MD and non-MD groups.
- Low-risk recipients showed better long-term survival when using MD hearts (p=0.01).
Conclusions:
- Selected marginal donor (MD) hearts can be utilized in HTx without increasing adverse events.
- MD hearts demonstrate excellent early and long-term outcomes, particularly in low-risk recipients.
- MD hearts represent a valuable resource to address donor shortages in HTx.
Background And Objectives:
Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx.
Methods:
Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed. MD was defined as follows; a donor age >55 years, left ventricular ejection fraction <50%, cold ischemic time >240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10).
Results:
A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01).
Conclusions:
The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and long-term outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.
