Outcomes of an alternate list strategy for heart transplantation

Abstract

24 weeks after transplantation in DCM patients only (pϽ0.01 vs. post-transplant weeks 6 and 12). Conclusions: These data indicate a significant PAI-1 upregulation associated with uPA downregulation in DCM independent of VEGF-A which was corrected by cardiac transplantation temporarily. However, reoccurring upregulated myocardial PAI-1 levels at 6 months following transplantation indicate a persistent PAI-1-related molecular pathology in DCM.Background: Heart transplantation (HT) is an effective therapy for end-stage heart failure, but its impact is limited by scarcity of donor organs and stringent criteria for donors and recipients. The creation of an alternate list (AL) to match recipients with contraindications to traditional HT with sub-optimal donor organs has been proposed, but outcomes with this approach are uncertain. Methods: We created an AL that matched recipients with contraindications to traditional HT with donor organs that had been rejected for use in standard transplantation. Baseline characteristics and outcomes were compared to a group of patients transplanted on the standard list (SL) over the same time period. Results: Since 2000, 46 patients received HT on the AL, compared to 189 on the SL. The most common reasons for recipient listing on the AL were ageϾ65 years (nϭ26) and diabetes with end organ damage (nϭ7). The most common reasons for allocation of donor organs to AL patients were positive hepatitis serology (nϭ12), LV dysfunction (nϭ10), and CAD (nϭ10). AL patients were older (62 vs. 51 years, pϽ0.001) and more likely to have ischemic heart failure (72% vs. 40%, pϽ0.001) and diabetes (39% vs. 21%, pϭ0.02). Differences in outcomes are shown in the table.

Impact of Donor Left Ventricular Hypertrophy on Survival After Heart Transplant

“…Previous investigations that explored the effect of donor LVH on post-transplant survival provided conflicting results (9)(10)(11)(16)(17)(18)(19). Therefore, it remains controversial whether donor cardiac allografts that demonstrate evidence of LVH on echocardiography can be used safely for transplantation.…”

Solid Organ Transplantation: An Ethical Dilemma – Case Report

“…Research shows that the risk of post-transplant malignancy is very low unless donor grafts with high grade CNS tumors are used. Therefore, the use of marginal donors for organ transplantation can improve both the length and the quality of waiting list patients with a high risk of mortality 3,4,10,[12][13][14] . Biopsy of specimens from the brain mass and liver graft for the classification and grading of CNS tumors, and abdominal screening of the donor are useful prior to transplantation.…”

“…However, her family members were informed in detail on her condition and the donor's attributes, and informed consent was obtained from them. It is recommended, in the management of this type of cases, to inform the patient or the family members in detail regarding the attributes of the marginal donor and to use a case-specific consent form that includes all that information as well 3,13,14 . The Universal Declaration of Bioethics and Human Rights states that the "sensibility of the individuals must be considered in the application and development of scientific knowledge, medical practices and related technologies.…”