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Impact of Reported Donor Ejection Fraction on Outcome after Heart TransplantationFunding None.
Objectives The global shortage of donor organs has urged transplanting units to extend donor selection criteria, for example, impaired left ventricular function (LVF), leading to the use of marginal donor hearts. We retrospectively analyzed our patients after orthotopic heart transplantation (oHTX) with a focus on the clinical outcome depending on donor LVF.
Methods Donor reports, intraoperative, echocardiographic, and clinical follow-up data of patients undergoing oHTX at a single-center between September 2010 and June 2020 were retrospectively analyzed. Recipients were divided into two groups based on donor left ventricular ejection fraction (dLVEF): impaired dLVEF (group I; dLVEF ≤ 50%; n = 23) and normal dLVEF group (group N; dLVEF > 50%; n = 137).
Results There was no difference in 30-day, 90-day, and 1-year survival. However, the duration of in-hospital stay was statistically longer in group I than in group N (N: 40.9 ± 28.3 days vs. I: 55.9 ± 39.4 days, p < 0.05). Furthermore, postoperative infection events were significantly more frequent in group I (p = 0.03), which was also supported by multivariate analysis (p = 0.03; odds ratio: 2.96; confidence interval: 1.12–7.83). Upon correlation analysis, dLVEF and recipient LVEF prove as statistically independent (r = 0.12, p = 0.17).
Conclusions Impaired dLVEF is associated with prolonged posttransplant recovery and slightly increased morbidity but has no significant impact on survival up to 1 year posttransplant.
Received: 16 December 2020
Accepted: 15 January 2021
16 April 2021 (online)
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- 1 Ponikowski P, Voors AA, Anker SD. et al; Authors/Task Force Members, Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18 (08) 891-975
- 2 Mehra MR, Canter CE, Hannan MM. et al; International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases, Pediatric and Heart Failure and Transplantation Councils. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant 2016; 35 (01) 1-23
- 3 Galeone A, Lebreton G, Coutance G. et al. A single-center long-term experience with marginal donor utilization for heart transplantation. Clin Transplant 2020; 34 (11) e14057
- 4 Guglin M. How to increase the utilization of donor hearts?. Heart Fail Rev 2015; 20 (01) 95-105
- 5 Hsu RB, Chu SH, Chien CY. et al. Heart transplantation with marginal recipients and donors. J Formos Med Assoc 1999; 98 (10) 663-667
- 6 Khush KK. Donor selection in the modern era. Ann Cardiothorac Surg 2018; 7 (01) 126-134
- 7 Kransdorf EP, Stehlik J. Donor evaluation in heart transplantation: the end of the beginning. J Heart Lung Transplant 2014; 33 (11) 1105-1113
- 8 Russo MJ, Davies RR, Hong KN. et al. Matching high-risk recipients with marginal donor hearts is a clinically effective strategy. Ann Thorac Surg 2009; 87 (04) 1066-1070 , discussion 1071
- 9 Lima B, Rajagopal K, Petersen RP. et al. Marginal cardiac allografts do not have increased primary graft dysfunction in alternate list transplantation. Circulation 2006; 114 (1, Suppl): I27-I32
- 10 Madan S, Sims DB, Vlismas P. et al. Cardiac transplantation using hearts with transient dysfunction: role of takotsubo-like phenotype. Ann Thorac Surg 2020; 110 (01) 76-84
- 11 Zaroff JG, Babcock WD, Shiboski SC, Solinger LL, Rosengard BR. Temporal changes in left ventricular systolic function in heart donors: results of serial echocardiography. J Heart Lung Transplant 2003; 22 (04) 383-388
- 12 Templin C, Ghadri JR, Diekmann J. et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373 (10) 929-938
- 13 Madan S, Saeed O, Vlismas P. et al. Outcomes after transplantation of donor hearts with improving left ventricular systolic dysfunction. J Am Coll Cardiol 2017; 70 (10) 1248-1258
- 14 Tryon D, Hasaniya NW, Jabo B, Razzouk AJ, Bailey LL, Rabkin DG. Effect of left ventricular dysfunction on utilization of donor hearts. J Heart Lung Transplant 2018; 37 (03) 349-357
- 15 Sibona A, Khush KK, Oyoyo UE. et al. Long-term transplant outcomes of donor hearts with left ventricular dysfunction. J Thorac Cardiovasc Surg 2019; 157 (05) 1865-1875
- 16 Oras J, Doueh R, Norberg E, Redfors B, Omerovic E, Dellgren G. Left ventricular dysfunction in potential heart donors and its influence on recipient outcomes. J Thorac Cardiovasc Surg 2020; 159 (04) 1333-1341.e6
- 17 Kobashigawa J, Khush K, Colvin M. et al. Report from the American Society of Transplantation Conference on Donor Heart Selection in Adult Cardiac Transplantation in the United States. Am J Transplant 2017; 17 (10) 2559-2566
- 18 Kilic A, Emani S, Sai-Sudhakar CB, Higgins RS, Whitson BA. Donor selection in heart transplantation. J Thorac Dis 2014; 6 (08) 1097-1104
- 19 Schumer EM, Ising MS, Trivedi JR, Slaughter MS, Cheng A. Early outcomes with marginal donor hearts compared with left ventricular assist device support in patients with advanced heart failure. Ann Thorac Surg 2015; 100 (02) 522-527
- 20 Donneyong M, Cheng A, Trivedi JR. et al. The association of pretransplant HeartMate II left ventricular assist device placement and heart transplantation mortality. ASAIO J 2014; 60 (03) 294-299