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Utilization and outcomes of cardiopulmonary resuscitated donor hearts in the modern era
Zach Rollins1, Ye In Christopher Kwon1, Mythili Vigneshwar1
1Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Va.
Insights
Donor hearts requiring cardiopulmonary resuscitation (CPR) are increasingly used, showing no difference in patient or graft survival. These CPR+ donor hearts, even after prolonged resuscitation, are safe for transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Donor hearts undergoing cardiopulmonary resuscitation (CPR) were historically deemed marginal.
- The utilization and outcomes of these CPR+ donor hearts require updated evaluation.
Purpose of the Study:
- To assess the impact of donor CPR on recipient outcomes in heart transplantation.
- To evaluate the contemporary use of CPR+ donor hearts.
Main Methods:
- Analysis of adult single heart transplants in the US (2014-2023).
- Kaplan-Meier survival curves and log-rank tests for patient and graft survival.
- Multivariate Cox-regression analysis incorporating CPR status.
Main Results:
- 15,601 CPR+ donors and 13,994 CPR- donors were identified.
- No significant difference in 5-year patient or graft survival between CPR+ and CPR- donors.
- CPR+ donors comprised over 50% of all donors since 2017, with increased utilization.
Conclusions:
- CPR+ donor hearts are increasingly utilized and represent the majority of donors.
- Patient and graft survival outcomes are equivalent for CPR+ hearts compared to CPR- hearts.
- Donor hearts subjected to CPR, irrespective of duration, are safe for transplantation.
Objective:
Donor hearts that have undergone cardiopulmonary resuscitation (CPR) were previously considered marginal donors. We aimed to determine how donor CPR influences recipient outcomes (CPR+ vs CPR-). Additionally, we evaluated the overall use of CPR+ donor hearts in the modern era.
Methods:
All single heart organ transplants in the United States from 2014 to 2023 were obtained for adults older than age 18 years. Survival curves were built for overall and graft survival using a Kaplan-Meier method with a log-rank test used to test for differences. Multivariate Cox-regression was performed on recipient survival with CPR status and other recipient variables as covariates.
Results:
From 2014 to 2023, there were 13 994 CPR- donors and 15 601 CPR+ donors throughout the study period. There was no significant difference in patient survival at 30 days, 1 year, and 5 years (P = .09). Graft survival over 5 years was similar between subgroups of CPR ≤15 minutes, 16 to 30 minutes, or >30 minutes (P = .94). Use of heart transplants from donors resuscitated using CPR increased throughout the study, with CPR+ donors representing >50% of all donors since 2017.
Conclusions:
Heart donors who are CPR+ are being used at an increased frequency and now represent most donors. CPR+ hearts have statistically equivalent patient and graft survival outcomes over 5 years. Hearts that have undergone CPR, even for periods of >30 minutes, can be safely utilized.
