Interactions among donor characteristics influence post-transplant survival: A multi-institutional analysis

Stehlik, Josef; Feldman, David S.; Brown, Robert N.; VanBakel, Adrian; Russel, Stewart D.; Ewald, Gregory A.; Hagan, Mary E.; Folsom, Jan W.; Kirklin, James K.

doi:10.1016/j.healun.2009.08.007

Cited by 100 publications

(78 citation statements)

References 24 publications

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“…Potential mechanisms by which donor/recipient gender mismatch might affect survival after transplantation include hormonal and genetic differences, antigen development and other immunologic factors, and size. Mismatch has been associated with organ failure [25,27], and results for acute rejection and cardiac allograft vasculopathy in sexmismatched patients are controversial, mainly owing to the large amount of missing results and differences in diagnostic criteria [28]. In our series, the predominant mortality in males with mismatched donors appears to occur at the time of transplant (Figs 1 and 2) and we found that male recipients with sex mismatch presented primary graft dysfunction more frequently than female recipients with sex mismatch (24.8% vs. 18.9%, Fig.…”

Section: Discussionmentioning

confidence: 99%

Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry

et al. 2014

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SummaryThe results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 AE 4.1 vs. 24.3 AE 3.7; P < 0.01), and male donors were younger than female donors (33.4 AE 12.7 vs. 38.2 AE 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with longterm mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.

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Section: Discussionmentioning

confidence: 99%

Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry

et al. 2014

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“…In that review, hearts from donors less than 20 years of age appeared to tolerate ischaemic times beyond six hours with no adverse impact on post-transplant survival, whereas hearts from donors older than 33 years demonstrated reduced survival when ischaemic time increased beyond 3.5 hours. In another study from the Cardiac Transplant Research Database Group, Stehlik et al reported that donor recipient weight differences interacted with age and gender [27]. In that study, weight differences of up to 30 % did not affect survival so long as the donor was 30 years or younger.…”

Section: Risk Factors For Pgdmentioning

confidence: 92%

Primary Graft Dysfunction After Heart Transplantation

et al. 2014

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Primary graft dysfunction (PGD) is a lifethreatening complication of heart transplantation that presents as left, right, or biventricular dysfunction occurring within the first 24 hours of transplant surgery for which there is no identifiable secondary cause. Myocardial injury caused by acute catecholamine toxicity and the release of multiple proinflammatory mediators in the donor, followed by ischaemiareperfusion injury sustained during retrieval, have been considered the predominant pathogenetic processes leading to PGD. Donor, recipient, and procedural factors contribute to the development and severity of the clinical syndrome. The changing donor and recipient characteristics over the last two decades, particularly the increasing donor and recipient age, have led to heightened risk of PGD. PGD is graded from mild to severe depending on the extent of circulatory support that is required to maintain haemodynamic stability and vital organ function. While advances in acute mechanical support devices have improved the outlook for patients with PGD, the rate of mortality remains high for those with severe PGD, reaching 40 %. Potential approaches to preventing or minimising the severity of PGD include optimising donor management, donor heart preservation, and donor/recipient matching.

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“…Relative contraindications to organ utilization include advanced patient age, although there is no firm cutoff, and human leukocyte antigen (HLA)-mismatch. [14][15][16][17] There is significant variation amongst centres, surgeons, regions, and organ procurement organizations on what constitutes an acceptable donor for individual organs.…”

Section: Résumémentioning

confidence: 99%