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Optimizing recovery of marginal donor hearts with low ejection fraction: A national retrospective study from
Raphaël Giraud1,2,3,4, Selina Adam5, Benjamin Assouline1,2,3
1Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland.
Insights
Optimized management can improve marginal donor hearts by restoring left ventricular function (LVEF), increasing heart transplant eligibility. Standardized guidelines can expand the donor pool for better outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donor Management
Background:
- Heart transplantation in Switzerland is limited by donor organ availability.
- Marginal donor hearts, often with reduced left ventricular ejection fraction (LVEF), are frequently declined.
- Optimized donor management may improve cardiac function and increase transplant eligibility.
Purpose of the Study:
- To investigate the impact of optimized donor management on the transplant eligibility of marginal donor hearts.
- To identify predictors of heart transplantation in brain-dead donors.
- To assess functional recovery of marginal donor hearts with improved LVEF.
Main Methods:
- Retrospective cohort study of 415 brain-dead donors (2017-2021).
- Donors classified as optimal (LVEF ≥50%) or marginal (LVEF 15-49%).
- Logistic regression used to identify predictors of transplantation; echocardiography assessed functional recovery.
Main Results:
- Transplantation rates were significantly higher for optimal hearts (62.7%) compared to marginal hearts (23.6%).
- LVEF ≥50% independently predicted transplantation (aOR=4.56).
- Marginal hearts showed significant LVEF improvement (p < 0.0001) after optimized management.
Conclusions:
- Optimized donor management can restore left ventricular function in marginal hearts, enhancing transplant eligibility.
- Tailored hemodynamic and pharmacologic strategies can mitigate reversible cardiac dysfunction.
- Standardized national guidelines could expand the donor pool and improve transplant outcomes.
Background:
In Switzerland, heart transplantation is limited by donor availability. Marginal donor hearts-characterized by older age, comorbidities, or reduced left ventricular ejection fraction (LVEF)-are often declined despite being structurally normal. Since impaired LVEF may be reversible, optimized donor management could improve cardiac function and transplant eligibility.
Methods:
This retrospective cohort study analyzed 415 brain-dead donors (2017-2021) from the Swiss Organ Allocation System. Donors were categorized as optimal (LVEF ≥50%) or marginal (LVEF 15-49%), irrespective of structural abnormalities, to focus on a modifiable functional parameter. Predictors of heart transplantation were assessed using univariate and multivariable logistic regression. Additional analyses evaluated hemodynamic monitoring, diagnostic strategies, management duration, and functional recovery based on serial echocardiography.
Results:
Among 415 donors, 287 were optimal and 62 marginal. Transplantation rates were higher in optimal hearts (62.7% vs. 23.6%, p < 0.001). LVEF ≥50% independently predicted transplantation (adjusted OR = 4.56; 95% CI: 2.34-8.89; p < 0.001), together with younger age, lower norepinephrine dose, central monitoring, and repeated echocardiography. Marginal hearts demonstrated significant improvement in LVEF after optimized management (p < 0.0001), suggesting that reversible dysfunction can be mitigated through tailored hemodynamic and pharmacologic strategies.
Conclusions:
Optimized donor management can restore left ventricular function in marginal hearts and enhance transplant eligibility. Standardized national guidelines may help expand the donor pool and improve transplantation outcomes.
