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Donor heart dysfunction and graft survival in liver and kidney transplants-A register-based study from Sweden
Carl Johan Svensson1,2, Josefin Öberg1, Göran Dellgren3
1Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Organ donors with left ventricular dysfunction (LV dysfunction) do not negatively impact liver and kidney transplant survival. This finding suggests that organs from these donors can be safely transplanted, improving organ availability.
Area of Science:
- Transplantation immunology
- Cardiology
- Organ donation
Background:
- Stress cardiomyopathy can affect organ donor graft function.
- Left ventricular ejection fraction (LVEF) < 50% or regional wall motion abnormalities (RWMA) may indicate donor cardiac issues.
- Assessing donor cardiac function is crucial for graft success.
Purpose of the Study:
- To investigate the association between donor LV dysfunction and short/long-term liver and kidney graft survival.
- To determine if echocardiographic indicators of LV dysfunction in organ donors impact graft outcomes.
- To identify donor and recipient characteristics influencing graft survival.
Main Methods:
- Retrospective analysis of liver and kidney donors with echocardiographic records (2006-2016).
- Matching donor data with recipient outcomes via the Scandiatransplant register.
- Utilizing Kaplan-Meier curves and multivariate Cox-regression for survival analysis.
Main Results:
- No statistical difference in short- and long-term graft survival was observed between donors with and without LV dysfunction.
- Donor age > 65, recipient re-transplantation, and recipient liver tumor predicted worse outcomes in liver transplants.
- Donor age > 65, donor hypertension, recipient re-transplantation, and recipient diabetes/nephritis negatively impacted kidney graft survival.
Conclusions:
- Donor left ventricular dysfunction is not significantly associated with reduced liver or kidney graft survival.
- Organs from donors with echocardiographic signs of LV dysfunction can be safely transplanted.
- This finding may expand the pool of viable donor organs.
Background And Aim:
Stress cardiomyopathy in donors can potentially affect graft function and longevity. This study aims to investigate the association between echocardiographic left ventricular ejection fraction (LVEF) < 50%, and/or the presence of left ventricular regional wall motion abnormalities (RWMA) in organ donors, and short- and long-term liver and kidney graft survival. Our secondary aim was to link graft survival with donor and recipient characteristics.
Methods:
All donors considered for liver and kidney donation with echocardiographic records at Sahlgrenska University Hospital between 2006 and 2016 were matched with their recipients through the Scandiatransplant register. The studied outcomes were graft survival, re-transplantation, and recipient death. Kaplan-Meier curves were used to plot time to event. Multivariate Cox-regression was used to test independence.
Results:
There were 370 liver donors and 312 kidney donors (matched with 458 recipients) with echocardiographic records at Sahlgrenska University Hospital between June 2006 and November 2016. Of patients with LV dysfunction by echocardiography, there were 102 liver- and 72 kidney donors. Univariate survival analyses showed no statistical difference in the short- and long-term graft survival from donors with LV dysfunction compared to donors without. Donor age > 65 years, recipient re-transplantation and recipient liver tumor were predictors of worse outcome in liver transplants (p < .05). Donor age > 65, donor hypertension, recipient re-transplantation, and a recipient diagnosis of diabetes or nephritis/glomerulonephritis had a negative association with graft survival in kidney transplants (p < .05).
Conclusion:
We found no significant association between donor LV dysfunction and short- and long-term graft survival in liver and kidney transplants, suggesting that livers and kidneys from such donors can be safely transplanted.
