Donor Heart Transient Left Ventricular Dysfunction is Associated with Post-Transplant Primary Graft Dysfunction

A. Bhatia, P. King, J. Ji, J. Schilling, J. Hartupee, G. Ewald

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1 Scopus citations

Abstract

PURPOSE: There is a significant unmet patient need for heart transplantation, driven partly by low donor heart utilization. Donor left ventricular dysfunction (LVD) is the most common reason for non-allocation. A significant proportion of brain-dead donors will have transient LVD with subsequent recovery, and these donor hearts are considered an underutilized subset. However, their association with post-transplant outcomes, specifically primary graft dysfunction (PGD), remains unclear. This study investigates the relationship between donor clinical characteristics and post-transplant PGD. METHODS: Donor and post-transplant data was obtained for all donor hearts originating from a centralized diagnostic and recovery OPO that were transplanted at a single institution between 2010-2017. Transient LVD was defined as initial LV ejection fraction (LVEF) at OPO <40% with subsequent normalization of LVEF. All donor hearts had an LVEF ≥50% at time of procurement. The primary outcome was ISHLT-defined LV PGD, and secondary outcomes included 30-day and 1-year mortality. RESULTS: 152 heart transplant patients were identified with corresponding donor hearts originating from the OPO, of which 32 (21%) had post-transplant PGD. PGD was not associated with donor baseline characteristics, pressor requirements, or lab values (Table 1). PGD was associated with lower donor final LVEF (57.5% vs. 60%, p<0.01). 36 (23%) donor hearts had transient LVD, while 116 (77%) did not. Among patients receiving donor hearts with transient LVD, there was a two-fold increased risk of PGD (41% vs. 19%, p=0.01, OR=2.1). Donor transient LVD was not associated with post-transplant 30-day or 1-year mortality. CONCLUSION: This study indicates that patients receiving donor hearts with transient LV dysfunction have a two-fold increased risk of PGD. Given these findings, vigilance for PGD, careful consideration regarding donor-recipient matching, and early hemodynamic support should be considered in these patients.

Original languageEnglish
Pages (from-to)S265
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020

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