Effect of left ventricular dysfunction on utilization of donor hearts

Tryon, David; Hasaniya, Nahidh; Jabo, Brice; Razzouk, Anees J.; Bailey, Leonard L.; Rabkin, David G.

doi:10.1016/j.healun.2017.07.015

Cited by 24 publications

(10 citation statements)

References 21 publications

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“…11,12 Despite some previous articles dealing with the outcome of marginal heart donors with impaired LV function, the principle controversy remains in the field of heart transplantation. In particular, as most of past studies were based on the organ network database, [13][14][15][16] individual centers follow regimen regarding acceptance of marginal organs. However, in the setting of large retrospective register studies that include a heterogenous set of various wide-ranged perioperative protocols from a large number of institutions, the individual setting for the obtained data is not uniform.…”

Section: Introductionmentioning

confidence: 99%

Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation

Sugimura

Immohr

Aubin

et al. 2021

Thorac Cardiovasc Surg

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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.

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Section: Introductionmentioning

confidence: 99%

Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation

Sugimura

Immohr

Aubin

et al. 2021

Thorac Cardiovasc Surg

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“…4 Left ventricular (LV) dysfunction may be the single largest potentially modifiable factor preventing hearts from being transplanted from otherwise eligible brain-dead organ donors. 5 A significant proportion of young donors may have reversible impairments in LV function that could improve over time after sympathetic-mediated injury. 6 However, time for donor management and organ allocation is often limited by competing factors and therefore not all hearts that might recover are utilized.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Intravenous Thyroxine for Brain-Dead Organ Donors With Impaired Cardiac Function

Dhar

Stahlschmidt²,

Marklin³

2019

Prog Transpl

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Rationale: Brain death (BD) precipitates cardiac dysfunction impairing the ability to transplant hearts from eligible organ donors. Retrospective studies have suggested that thyroid hormone may enhance myocardial recovery and increase hearts transplanted. We performed a randomized trial evaluating whether intravenous thyroxine (T4) improves cardiac function in BD donors with impaired ejection fraction (EF). Methods: All heart-eligible donors managed at a single-organ procurement organization (OPO) underwent protocolized fluid resuscitation. Those weaned off vasopressors underwent transthoracic echocardiography (TTE) within 12 hours of BD and, if EF was below 60%, were randomized to T4 infusion or no T4 for 8 hours, after which TTE was repeated. Results: Of 77 heart-eligible donors, 36 were weaned off vasopressors. Ejection fraction was depressed in 30, of whom 28 were randomized to T4 (n = 17) vs control (n = 11). Baseline EF was comparable (45%, interquartile range [IQR] 42.5-47.5 vs 40%, 40-50, P = .32). Ejection fraction did not improve more with T4 (10%, IQR 5-15 vs 5%, 0-12.5, P = .24), although there was a trend to more hearts transplanted (59% vs 27%, P = .14). This difference appeared to be accounted for by more donors with a history of drug use in the T4 group, who exhibited greater improvements in EF (15% vs 0% without drug use, P = .01) and more often had hearts transplanted (12 of 19 vs 1 of 9, P = .01). Conclusions: In this small randomized study of BD donors with impaired cardiac function, T4 infusion did not result in greater cardiac recovery. A larger randomized trial comparing T4 to placebo appears warranted but would require collaboration across multiple OPOs.

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“…In donors assessed for cardiac transplantation, LV dysfunction is cited as one of the most common contraindications for organ procurement, with one study finding this to be the case in up to 19% of non-utilized hearts. 14,15 A recent study showed that, although hearts with LV dysfunction as determined by preprocurement echocardiography were often declined, the presence of LV dysfunction in donor organs had no significant impact on post-transplant outcomes. 16 An NEVP system that allows for assessment of organ function and recovery postprocurement could potentially increase donor pool with organs that would have previously been declined.…”

Section: Discussionmentioning

confidence: 99%

Prolonged (24-hour) Normothermic ex vivo Heart Perfusion Facilitated by Perfusate Hemofiltration

Johnson¹,

Fallon²,

Langley³

et al. 2022

ASAIO Journal

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Currently, normothermic ex vivo heart perfusion (NEVHP) is limited to 6-12 hours. NEVHP for 24 hours or more would allow organ treatment, assessment of organ function, and nearperfect recipient matching. We present a model of NEVHP using continuous hemofiltration (HFn) with sustained myocardial viability up to 24 hours. Twenty hearts from 6-10 kg piglets were procured and maintained on our NEVHP circuit. HFn hearts (n = 10) underwent NEVHP with HFn, whereas controls (n = 10) used NEVHP alone. All HFn vs. four controls were viable at 24 h (p = 0.004). At end perfusion, HFn hearts had higher left ventricular systolic pressure (51.5 ± 6.8 mm Hg, 38.3 ± 5.2 mm Hg, p = 0.05), lower coronary resistance (0.83 ± 0.11 mm Hg/mL/min, 1.18 ± 0.21mmHg/mL/min, p < 0.05), and lower serum lactate levels (2.9 ± 0.4 mmol/L, 4.1 ± 0.6 mmol/L, p < 0.0001) when compared to control hearts. HFn hearts also had less extensive myocardial damage and significantly less edema than control hearts with lower weight gain and wet-dry ratios. Using our circuit, NEVHP for 24 hours is possible with HFn and allows for preservation of myocardial function, improved tissue viability, decreased tissue edema, and less myocardial injury.

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Effect of left ventricular dysfunction on utilization of donor hearts

Cited by 24 publications

References 21 publications

Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation

Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation

A Randomized Trial of Intravenous Thyroxine for Brain-Dead Organ Donors With Impaired Cardiac Function

Prolonged (24-hour) Normothermic ex vivo Heart Perfusion Facilitated by Perfusate Hemofiltration

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