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Hemodynamic follow-up of cardiac allografts from poisoned donors
G Tenderich1, M M Koerner, H Posival
1Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Insights
Transplanting hearts from donors with acute poisoning is feasible, offering a life-saving option when organs are scarce. Careful donor selection ensures good patient outcomes, with 5-year survival at 74%.
Area of Science:
- Cardiology
- Transplantation Medicine
- Toxicology
Background:
- Increasing demand for cardiac allografts and donor organ shortages necessitate expanded donor criteria.
- The use of organs from donors after acute poisoning for cardiac transplantation is under-explored.
- This study details the experience with 19 heart transplant recipients receiving organs from donors with diverse intoxications.
Purpose of the Study:
- To evaluate the safety and efficacy of using cardiac allografts from donors with acute poisoning.
- To assess the outcomes of orthotopic heart transplantation using extended donor criteria.
Main Methods:
- Retrospective analysis of 883 orthotopic heart transplantations performed between March 1989 and December 1997.
- Inclusion of donor hearts from patients with various acute intoxications (e.g., ethanol, carbon monoxide, digitalis, cyanide).
- Hemodynamic data at organ explantation were collected for all donors.
Main Results:
- Early mortality in the cohort receiving organs from intoxicated donors was 11%.
- Cumulative survival after 5 years for these recipients reached 74%.
- Hemodynamic stability and absence of specific biomarkers (ECG changes, elevated transaminases) were key factors.
Conclusions:
- Cardiac allografts from donors with acute poisoning can be successfully transplanted in selected cases.
- Careful donor organ assessment, including hemodynamic status and biochemical markers, is crucial.
- This approach represents a viable, life-saving option in the context of organ scarcity.
Background:
The current shortage of donor organs, combined with an increasing demand for cardiac allografts, means that extended donor criteria are becoming more and more accepted. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion; few data are currently available in the medical literature. We describe our experience with 19 orthotopic heart transplant recipients of organs from donors after acute intoxication with different agents.
Methods:
Between March 1989 and December 1997, 883 orthotopic heart transplantations were performed at our transplant unit. Within this group, we accepted donor hearts after ethanol intoxication (n=1), benzodiazepine (n=1), alkylphosphate (E 605) in combination with beta-blocker intoxication (n=1), carbon monoxide poisoning (n=5), digitalis (n=1), digitalis/glibenclamide (n=1), chlormethiazole (n=1), propoxyphene (n=1), alkylphosphate (E 605) (n=1), insulin (n=2), neprobamate/ thiocyacide/flurazepam (n=1), paracetamol (n=1), carbamazepine (n=1), and cyanide (n=1) intoxication. At the time of organ explantation, hemodynamic data were available from all patients.
Results:
Early mortality in this group was 11%; cumulative survival after 5 years was 74%.
Conclusions:
Based on our limited experience, cardiac allografts from donors exposed to different kinds of poisons can be transplanted in selected cases. If the donor organ is not hemodynamically compromised, showing regular filling pressures on low or mild inotropic support just before explantation, and if there are no electrocardiographic changes in combination with elevation of the transaminases, cardiac allograft transplantation seems to be a safe and life-saving procedure.