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Distant heart procurement for transplantation
Insights
Utilizing donor hearts from distant hospitals for cardiac transplantation yielded comparable outcomes to using local donor hearts. This practice expands the donor pool for heart transplant recipients without compromising results.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- Cardiac transplantation is a life-saving procedure for end-stage heart failure.
- Donor heart availability is a significant limiting factor in expanding heart transplantation.
- Procurement of donor hearts from distant locations may increase the donor pool but raises concerns about ischemia time and outcomes.
Purpose of the Study:
- To compare the outcomes of cardiac transplantation using donor hearts procured from distant hospitals versus local hospitals.
- To evaluate the impact of increased ischemia time associated with distant heart procurement on patient survival and graft function.
Main Methods:
- Retrospective analysis of 39 cardiac transplants performed between January 1977 and September 1978.
- Comparison of recipient and donor characteristics, focusing on ischemia time (local vs. distant procurement).
- Assessment of key outcomes including immediate myocardial function, need for inotropic support, 90-day mortality, serum enzyme levels, rejection, infection, and histological findings.
Main Results:
- Donor hearts from distant hospitals had significantly longer mean ischemia times (154 minutes) compared to local hearts (52 minutes).
- Overall mortality rates were similar between the distant (32%) and local (40%) heart groups.
- No significant differences were observed in immediate myocardial function, postoperative support, early/late mortality, enzyme levels, rejection, or infection rates.
Conclusions:
- Cardiac transplantation using donor hearts from distant hospitals yields results comparable to those using locally procured hearts.
- Distant heart procurement effectively expands the donor pool for potential cardiac recipients.
- Increased ischemia time in distant procurements did not adversely affect short-term or long-term transplant outcomes in this cohort.
Abstract:
Between January 1, 1977, and September 15, 1978, 39 cardiac transplants were performed on 38 patients. Twenty donor hearts were removed at Stanford University Hospital, and 19 donor hearts were removed at distant hospitals. The characteristics of recipients and donors in both groups were similar. The only significant difference between donor hearts was the mean ischemia time (154 +/- 30 minutes in distant hearts and 52 +/- 12 minutes in local hearts, P less than 0.001). As of February 1, 1979, the total mortality rate was 32% for the distant heart donors and 40% for the local heart donors. No difference between the two groups was present in immediate myocardial function, the need for postoperative inotropic support, the mortality rate within the first 90 days after operation, the mean maximum serum enzyme levels, the occurrence of rejection or infection, and the histological appearance of the hearts, both early and late. The results of cardiac transplantation when hearts are removed at distant hospitals are entirely comparable to the results with hearts removed on site with a minimum ishchemic time. Distant heart procurement provides an expanded donor pool for potential cardiac recipients.