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Impact of Donor Hemodynamics on Recipient Survival in Heart Transplantation
Sheng Fu1, Chakradhari Inampudi1, Bhavadharini Ramu1
1From the Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC.
Insights
Donor heart hemodynamics assessed by right-heart catheterization do not impact recipient survival after heart transplantation. Abnormal hemodynamics in donor hearts may expand the donor pool for heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Heart transplantation is the primary treatment for end-stage heart failure.
- Low donor heart utilization rates persist due to non-evidence-based factors.
- The effect of donor hemodynamics on recipient survival is not well-established.
Purpose of the Study:
- To investigate the impact of donor hemodynamics, assessed via right-heart catheterization, on recipient survival following heart transplantation.
- To determine if abnormal donor hemodynamics affect post-transplant outcomes.
Main Methods:
- Utilized the United Network for Organ Sharing registry (September 1999-December 2019).
- Analyzed donor hemodynamic data using univariate and multivariable logistic regression.
- Primary endpoints included 1- and 5-year post-transplant survival rates.
Main Results:
- 7.7% of donors underwent right-heart catheterization; 5531 hearts were transplanted.
- Recipients of hearts from donors with hemodynamic assessment showed similar survival rates (87% at 1 year) compared to those without (86% at 1 year).
- Abnormal donor hemodynamics were common but did not negatively impact recipient survival, even after risk adjustment.
Conclusions:
- Donor hemodynamic assessment via right-heart catheterization does not adversely affect recipient survival.
- Abnormal hemodynamics in donor hearts may represent a viable option to increase the donor heart pool.
- This finding could potentially improve organ availability for heart transplantation.
Background:
Heart transplantation is the gold-standard therapy for end-stage heart failure, but rates of donor-heart use remain low due to various factors that are often not evidence based. The impact of donor hemodynamics obtained via right-heart catheterization on recipient survival remains unclear.
Methods:
The United Network for Organ Sharing registry was used to identify donors and recipients from September 1999-December 2019. Donor hemodynamics data were obtained and analyzed using univariate and multivariable logistical regression, with the primary endpoints being 1- and 5-year post-transplant survival.
Results:
Of the 85,333 donors who consented to heart transplantation during the study period, 6573 (7.7%) underwent right-heart catheterization, of whom 5531 eventually underwent procurement and transplantation. Donors were more likely to undergo right-heart catheterization if they had high-risk criteria. Recipients who had donor hemodynamic assessment had 1- and 5-year survival rates similar to those without donor hemodynamic assessment (87% vs 86%, 1 year). Abnormal hemodynamics were common in donor hearts but did not impact recipient survival rates, even when risk-adjusted in multivariable analysis.
Conclusions:
Donors with abnormal hemodynamics may represent an opportunity to expand the pool of viable donor hearts.
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