Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation

Abstract

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.

Extended criteria donor organ use for heart-lung transplantation in the modern era

“…The relative safety of using ECD hearts and ECD lungs is consistent with existing literature showing that the use of ECD hearts or lungs in single-organ transplantation yields comparable outcomes to using SCD organs 1 , 2 , 3 , 4 , 5 , 6 . The present study is unique in demonstrating the safety of ECD organs in the setting of simultaneous HLTx, which is consistent with the literature on single-organ thoracic transplants.…”

“…Donor hearts and lungs were determined to be ECD organs if they satisfied two ECD criteria ( Table 1 ). ECD criteria were adapted from the literature describing extended criteria in hearts [ 1 , 3 , 4 , 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] and lungs [ 2 , 6 , 7 , 8 , 17 ].…”

“…Several transplant centers have found comparable outcomes between recipients of carefully selected ECD hearts and recipients of Standard Criteria Donor (SCD) hearts [1] . The extended heart criteria found to minimally impact morbidity and mortality include age over 50 [1] , norepinephrine requirement [3] , hepatitis C positivity [ 1 , 4 ], left ventricular ejection fraction < 50% [5] , and donor/recipient weight ratio less than 0.80 [1] . Extended lung criteria found to minimally impact these outcomes include age over 50 [6] , tobacco use history [7] , and hepatitis C positivity [8] .…”

Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era

“…7 However, even with this improved technology, the mortality of PCCS remains high, with a single-center study of PCCS patients undergoing Impella support reporting an in-hospital mortality of 51.6%. 43 Therefore, improved strategies focused on the prevention and prophylaxis of PCCS are needed.…”

Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit

“…The effect of donor parameters on outcome and survival after heart transplantation is crucial and is currently one of the most essential topics of organ acceptance [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. A potential donor risk factor for organ quality is the donor length of stay (LOS) in the ICU.…”