High-dose catecholamine donor support and outcomes after heart transplantation

Angleitner, Philipp; Kaider, Alexandra; Gökler, Johannes; Moayedifar, R.; Osorio-Jaramillo, Emilio; Zuckermann, Andreas; Laufer, Günther; Aliabadi-Zuckermann, Arezu

doi:10.1016/j.healun.2017.12.015

Cited by 19 publications

(21 citation statements)

References 31 publications

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“…In our series, low D/R‐PHM ratio and ischemic time >4 hours were not predictive of mortality, while high‐dose inotropic support was an independent risk factor of mortality after HT only at univariate analysis. Previous reports showed association between donor norepinephrine use and PGD, 30 conversely a recent paper showed that in the presence of favorable recipient‐donor sex combinations and short ischemic times, donor norepinephrine dose is not associated with mortality and PGD 31 . Donor age is a well‐known risk factor of mortality after HT 32 especially when it is associated with a prolonged ischemic time 33 and our results confirmed that donor age >55 years is an independent risk factor of mortality at multivariate analysis.…”

Section: Discussionsupporting

confidence: 83%

A single‐center long‐term experience with marginal donor utilization for heart transplantation

Galeone

Lebreton

Coutance

et al. 2020

Clinical Transplantation

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Background: To evaluate the early and late outcome of heart transplantation (HT) using marginal (MDs) and optimal donors (ODs). Methods: Clinical records of recipients transplanted between July 2004 and December 2014 were retrospectively reviewed. MDs were defined as follows: age >55 years, high-dose inotropic support, left ventricular ejection fraction <45%, left ventricular hypertrophy, donor to recipient predicted heart mass ratio <0.86, ischemic time >4 hours. Results: A total of 412 (55%) recipients received an organ from a MD; recipients who received an organ from an OD had less primary graft dysfunction (PGD) (25% vs 38%; P < .001), less acute renal failure (23% vs 34%; P < .001), and higher survival rates (90.2% vs 81.8% at 30 days, 79.5% vs 71.1% at 1 year, 51.8% vs 45.4% at 12 years; P = .01) than recipients who received an organ from a MD. There was no statistically significant difference in 30-day conditional survival between the two groups (survival rates 57.4% vs 55.5% at 12 years; P = .43). PGD, perioperative hemodialysis, and sepsis were independent risk factors of mortality at multivariate analysis. Conclusions: Utilization of MDs for HT is associated with a higher incidence of PGD and acute renal failure, and a reduction of 30-day survival.

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Section: Discussionsupporting

confidence: 83%

A single‐center long‐term experience with marginal donor utilization for heart transplantation

Galeone

Lebreton

Coutance

et al. 2020

Clinical Transplantation

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“…40 Higher doses of these agents (>0.2 mg/kg/min) have been reported to increase the risk of cardiac injury, 35,41,42 although in recent literature, the use of norepinephrine in the donor has been deemed safe. Angleitner et al 43 reported no significant differences in 30-day and 1-year mortality, primary graft dysfunction, and the need for renal replacement therapy after heart transplantation when heart donors who did not require vasopressors were compared against those who were on low-dose norepinephrine (0.01−0.1 mg/kg/min), or when those on low-dose norepinephrine (0.01−0.1 mg/kg/min) were compared with those on higher-dose norepinephrine (>0.1 mg/kg/min). 43 Recipients who received hearts from donors on norepinephrine had prolonged intensive care unit (ICU) length of stay.…”

Section: Inotropic and Vasopressor Supportmentioning

confidence: 99%

“…Angleitner et al 43 reported no significant differences in 30-day and 1-year mortality, primary graft dysfunction, and the need for renal replacement therapy after heart transplantation when heart donors who did not require vasopressors were compared against those who were on low-dose norepinephrine (0.01−0.1 mg/kg/min), or when those on low-dose norepinephrine (0.01−0.1 mg/kg/min) were compared with those on higher-dose norepinephrine (>0.1 mg/kg/min). 43 Recipients who received hearts from donors on norepinephrine had prolonged intensive care unit (ICU) length of stay. 43 Hence, echocardiograms should be interpreted in the context of vasopressor(s) support that the donor was receiving at the time of the study and may need to be repeated.…”

Section: Inotropic and Vasopressor Supportmentioning

confidence: 99%

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Donor heart and lung procurement: A consensus statement

Copeland

Hayanga

Neyrinck

et al. 2020

The Journal of Heart and Lung Transplantation

127

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“…Indeed, high inotrope dependence and significant myocardial dysfunction can prohibit organ donation (based on medical grounds) [340,341]. Due to the shortage of acceptable donor hearts, several studies have demonstrated that using these “extended criteria” donors on high inotrope support is an acceptable strategy for expanding the donor pool [342,343,344]. Conversely, left ventricular mechanical unloading (as occurs with VAD implantation, V-A-ECMO) increases β 1 -AR [345] and β 2 -AR mRNA expression (also tolerance to IRI) [346], and reduces GRK2 expression and activity [347,348], which may explain the improved β-AR responsiveness and total β-AR density observed post-VAD implantation [347,348,349].…”

Section: Cardioprotection With Inotropic Supportmentioning

confidence: 99%

Hurdles to Cardioprotection in the Critically Ill

Hoe

Bartnikowski

Wells

et al. 2019

IJMS

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Cardiovascular disease is the largest contributor to worldwide mortality, and the deleterious impact of heart failure (HF) is projected to grow exponentially in the future. As heart transplantation (HTx) is the only effective treatment for end-stage HF, development of mechanical circulatory support (MCS) technology has unveiled additional therapeutic options for refractory cardiac disease. Unfortunately, despite both MCS and HTx being quintessential treatments for significant cardiac impairment, associated morbidity and mortality remain high. MCS technology continues to evolve, but is associated with numerous disturbances to cardiac function (e.g., oxidative damage, arrhythmias). Following MCS intervention, HTx is frequently the destination option for survival of critically ill cardiac patients. While effective, donor hearts are scarce, thus limiting HTx to few qualifying patients, and HTx remains correlated with substantial post-HTx complications. While MCS and HTx are vital to survival of critically ill cardiac patients, cardioprotective strategies to improve outcomes from these treatments are highly desirable. Accordingly, this review summarizes the current status of MCS and HTx in the clinic, and the associated cardiac complications inherent to these treatments. Furthermore, we detail current research being undertaken to improve cardiac outcomes following MCS/HTx, and important considerations for reducing the significant morbidity and mortality associated with these necessary treatment strategies.

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High-dose catecholamine donor support and outcomes after heart transplantation

Cited by 19 publications

References 31 publications

A single‐center long‐term experience with marginal donor utilization for heart transplantation

A single‐center long‐term experience with marginal donor utilization for heart transplantation

Donor heart and lung procurement: A consensus statement

Hurdles to Cardioprotection in the Critically Ill

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