Is coronary atherosclerosis of the donor heart acceptable?

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

“…16 Regarding donors with preexisting cardiac disease, donor CAD is associated with early graft failure as well as development of cardiac allograft vasculopathy and diastolic heart failure, with consequent suboptimal long-term survival in the case of donors with left ventricular hypertrophy (LVH). 16 Although reports suggest the risk of early graft failure is strikingly more frequent in those with 2-or 3-vessel disease (42.3%), with only marginal increased risk in those with 1-vessel disease compared with no CAD (7.5% vs. 6.3%), 17 the lack of significant data has led to the ISHLT guidelines recommending avoidance of donor hearts with obstructive CAD in any major epicardial coronary artery. 16 Recent studies, meanwhile, have shown that mild or moderate LVH does not lead to an increased early or longer-term (median 4 years) mortality compared with donor hearts without LVH; 18 however, early mortality was increased in one study if left ventricular wall thickness exceeded 14 mm.…”