Low ejection fraction in donor hearts is not directly associated with increased recipient mortality

Chen, Carol W.; Sprys, Michael H.; Gaffey, Ann C.; Chung, Jennifer J.; Margulies, Kenneth B.; Acker, Michael A.; Atluri, Pavan

doi:10.1016/j.healun.2017.02.001

Cited by 58 publications

(50 citation statements)

References 15 publications

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“…A recent UNOS registry analysis used propensity score analysis to examine post-operative outcomes of recipients of donor hearts with left ventricular ejection fraction <40% (reduced), 40-50% (borderline), and ≥50% (normal) and showed equivalent odds of primary graft failure and death at 1 year in all 3 groups. At 1-year post-transplant, the mean ejection fraction was normal in recipients of donor hearts with reduced systolic function (24). There is certainly a concern for selection bias in such studies, as we cannot know the outcomes of donor hearts with left ventricular dysfunction that were declined for transplantation.…”

Section: Donor Left Ventricular Dysfunctionmentioning

confidence: 99%

Donor selection in the modern era

Khush

2018

Ann. Cardiothorac. Surg.

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The growing disparity between the supply of donor hearts for transplantation and the demand for such organs has led to liberalization of the criteria for donor heart acceptance over the past few decades. The upper age limit and size restrictions for donor heart acceptance continue to be revised and hearts are being routinely used from donors with left ventricular dysfunction, left ventricular hypertrophy (LVH), cocaine use, multiple medical co-morbidities and after cardiopulmonary resuscitation. This article reviews recent data for use of such "expanded criteria" donor hearts and suggests ways to further increase the donor pool, including use of hearts from donors with hepatitis C and after circulatory determination of death. Donor biomarkers and risk scores may eventually aid in heart acceptance decisions, while ethical issues surrounding information sharing with transplant recipients remain a topic of great debate.

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Section: Donor Left Ventricular Dysfunctionmentioning

confidence: 99%

Donor selection in the modern era

Khush

2018

Ann. Cardiothorac. Surg.

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“…5,11 This is supported by both experimental 12 and clinical 10,[13][14][15] evidence in adults that hearts damaged by brain-death pathophysiology are capable of functional resuscitation. We, and others, have also demonstrated that hearts with poor ventricular function can be transplanted in both the pediatric [16][17][18] and adult [19][20][21][22][23] populations, with results equivalent to those seen for normally functioning donor hearts.…”

mentioning

confidence: 66%

Effect of left ventricular dysfunction on utilization of donor hearts

Tryon

Hasaniya

Jabo

et al. 2018

The Journal of Heart and Lung Transplantation

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“…Furthermore, our parameters for the ideal donor heart are far more restrictive than current practice, especially with regard to normal ejection fraction, as there are data to support that lower ejection fraction hearts are acceptable organs, especially when procured from young donors. 25,26 In addition, our study was limited by the small volume of DCD donor information available for review. Finally, given the sensitivity of detailed donor information, one-time chart review of DCD donors in Region 9 that were not accessed for clinical reasons limited our ability to expand this study to other Regions in the United States.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our parameters for the ideal donor heart are far more restrictive than current practice, especially with regard to normal ejection fraction, as there are data to support that lower ejection fraction hearts are acceptable organs, especially when procured from young donors 25,26. If this number were to increase by even 2-fold, this would yield a significant increase in the heart donor pool, suggesting that our study likely underestimates the potential of DCD donation.…”

mentioning

confidence: 93%

Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset

Farr

Truby

Lindower³

et al. 2020

American Journal of Transplantation

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Donation after Circulatory Death (DCD) is an alternative to Donation after Brain death (DBD), and is a growing strategy for organ procurement in the United States(US). The purpose of this analysis was to review the number and quality of hearts in one United Network for Organ Sharing (UNOS) Region that were not utilized as a potential consequence of nonheart DCD donation. We retrospectively identified all successful US DCD solid organ donors from 1/2011 to 3/1/2017, defined an ideal heart donor by age and left ventricular ejection fraction (LVEF), and then reviewed the donor charts of unused hearts in New York and Vermont (UNOS Region 9). Of 8302 successful DCD donors across the United States, 5033 (61%) were between 18 and 49 years of age, and 872 had a screening echocardiogram, with 573 (66%) measuring an EF >50%.Of these 573 potential donors, 44 (7.7%) were from Region 9. Detailed donor chart review identified 36 ideal heart donors, 24 (66.7%) with anoxic brain injury. Trends in Region 9 DCD donation increased from 4 unused hearts in 2011, to 13 in 2016. In the context of severe organ scarcity, these data indicate that implementation of DCD heart transplantation in the United States would improve overall donation rates and provide a pathway to utilize these ideal donor hearts. K E Y W O R D Sclinical research/practice, donors and donation: donation after circulatory death (DCD), donors and donation: donor evaluation, donors and donation: extended criteria, ethics and public policy, heart transplantation/cardiology

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Low ejection fraction in donor hearts is not directly associated with increased recipient mortality

Abstract: Recipients of hearts with reduced EF have equivalent 1-year survival compared with recipients of hearts with normal EF. Donor hearts with reduced EF show significant functional recovery after transplant.

Cited by 58 publications

References 15 publications

Donor selection in the modern era

Donor selection in the modern era

Effect of left ventricular dysfunction on utilization of donor hearts

Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset

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