Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac transplantation

Morgan, Jeffrey A.; John, Ranjit; Weinberg, Alan; Kherani, Aftab R.; Colletti, Nicholas; Vigilance, Deon W.; Cheema, Faisal H.; Bisleri, Gianluigi; Cosola, Thomas; Mancini, Donna; Öz, Mehmet C.; Edwards, Niloo M.

doi:10.1016/s0022-5223(03)01026-2

Cited by 68 publications

(53 citation statements)

References 19 publications

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“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Current donor and recipient criteria limit the use of hearts to donors who are within approximately 20% of the recipient's weight or a DR weight ratio of 0.8 to 1.2. Previous studies analyzing the impact of donor-to-recipient size have done so from an institutional perspective or as a subanalysis of a larger study.…”

Section: Patel Et Al Dr Weight Ratio and Htx S85mentioning

confidence: 99%

“…1 Because of the donor organ deficit, efforts have been made to use marginal donors in an attempt to increase the donor organ pool and reduce waiting list mortality. [2][3][4][5][6][7] These attempts include the use of hearts from older donors 8 -11 and hearts that have been subjected to longer ischemic times, [12][13][14][15][16] both of which have led to conflicting results in the literature.…”

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confidence: 99%

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Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

et al. 2008

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Background-Generally accepted donor criteria for heart transplantation limit allografts from donors within approximately 20% to 30% of the recipient's weight. We analyzed the impact of donor-to-recipient weight ratio on survival after heart transplantation. Methods and Results-Adult heart transplant recipients reported to the United Network for Organ Sharing from 1999 to 2007 were divided into 3 groups based on donor-to-recipient weight ratio: Ͻ0.

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Section: Patel Et Al Dr Weight Ratio and Htx S85mentioning

confidence: 99%

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confidence: 99%

Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

et al. 2008

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“…Earlier reports have concluded that prolonged cold ischemic time is not a risk factor for decreased long-term survival in cardiac allograft recipients (Morgan et al, 2003), yet more recent studies have indicated that it is a predictor of a 5-year conditional mortality (Taylor et al, 2008). The effect of cold ischemic time on survival after heart transplantation is dependent on donor age, with greater tolerance among grafts from younger donors (Russo et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Dopamine and Lipophilic Derivates Protect Cardiomyocytes against Cold Preservation Injury

Vettel

Hottenrott

et al. 2013

J Pharmacol Exp Ther

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Donor heart allografts are extremely susceptible to prolonged static cold storage. Because donor treatment with low-dose dopamine improves clinical outcome after heart transplantation, we tested the hypothesis that dopamine and its lipophilic derivate, N-octanoyl dopamine (NOD), protect cardiomyocytes from cold storage injury. Neonatal rat cardiomyocytes were treated with dopamine or NOD or left untreated and subsequently subjected to static cold storage (8-12 hours). Dopamine-and NOD-treated cardiomyocytes displayed a better viability compared with untreated cells after hypothermia. In untreated cardiomyocytes, cell damage was reflected by lactate dehydrogenase (LDH) release and a decrease in intracellular ATP. NOD was approximately 20-fold more potent than dopamine. Similarly to cardiomyocytes in vitro, rat hearts perfused with NOD before explantation showed significantly lower LDH release after static cold storage. ATP regeneration and spontaneous contractions after cold storage and rewarming only occurred in treated cardiomyocytes. Hypothermia severely attenuated isoprenaline-induced cAMP formation in control but not in dopamine-or NOD-treated cells. Esterified derivates of NOD with redox potential and lipophilic side chains reduced cell damage during cold storage similarly to NOD. In contrast to dopamine, neither NOD nor its derivates induced a significant b-adrenoceptor-mediated elevation of cellular cAMP levels. The b 1 -adrenoceptor antagonist atenolol and D 1 /D 2 receptor antagonist fluphenazine had no impact on the protective effect of NOD or dopamine. We conclude that dopamine as well as NOD treatment mitigates cold preservation injury to cardiomyocytes. The beneficial effects are independent of b-adrenoceptor or dopaminergic receptor stimulation but correlate with redox potential and lipophilic properties.

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“…[8] Several studies have also reported reduced survival rates in patients with prolonged donor ischemic time, [4,6,[9][10][11] but other studies have not shown any connection. [1,12,13] Kilic et al [11] studied 9,404 patients who underwent an orthotopic heart transplantation from 1987 to 1999 and concluded that younger patient age (<55 years), a shorter donor ischemic time, and younger donor age were the most important factors for predicting the 10-year survival rate after cardiac transplantation. In addition, they also concluded that being Caucasian was also a significant factor.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the diminishing number of brain death cases, a reduction of organ donations because of ethical or religious considerations has given rise to a decrease in local donor heart pools, so heart transplantation teams have started to harvest donor organs from more distant locations thanks to improvements in donor heart preservation methods that permit prolonged storage and the remote procurement of cardiac allografts. [1] As long as there are favorable survival rates for the recipients with allografts transplanted from far outside the generally accepted boundaries of donor age and ischemic time, transplantation teams will necessarily stretch the limits on the criteria for donor hearts. In the present study, we evaluated the effects of donor ischemic time and age on longterm mortality among patients who underwent heart transplantation in our clinic.…”

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confidence: 99%

The effect of donor ischemic time on mortality in heart transplanted patients

Yağdı¹

2014

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada kalp nakli yapılan hastalarda donör iskemi süresinin mortalite üzerindeki etkileri değerlendi-rildi. Ça lış ma pla nı: Mart 1998 -Eylül 2012 tarihleri arasında kliniğimizde kalp nakli uygulanan 172 hasta (135 erkek, 37 kadın; ort. yaş 39.7±14.6 yıl; dağılım 5-65 yıl) retrospektif olarak incelendi. Hastalar greft iskemi süresinin 200 dakika ve üzeri olması (group 1) ya da 200 dakikanın altında olmasına (group 2) göre iki gruba ayrıldı. Donör iskemi süresi ile mortalite arasındaki muhtemel ilişki erken, orta ve geç takip dönemlerinde değerlendirildi. Bul gu lar: Ortalama donör yaşı ve takip süresi sırasıyla 29.9±11.8 yıl ve 1295.0±1249.1 gün idi. Ortalama genel donör iskemi süresi 181.7±61.2 dk. olmakla birlikte, bu süre grup 1'de 244.0±36.9 dk., grup 2'de 139.0±30.1 dk. idi. Grup 1'de daha yüksek ameliyat sırası mortalite oranları saptanmasına rağmen (p=0.048), iki çalışma grubu arasında ameliyat sonrası mortalite açısından istatistiksel anlamlı bir fark saptanmadı. Çalışma gruplarının her biri donör yaşına göre (≤25 yıl, 26-39 yıl ve ≥40 yıl), altı alt gruba ayrıldı ve bu alt çalışma grupları arasında genel mortalite oranları açısından istatistiksel anlamlı bir farka rastlanmadı (p=0.307). So nuç:Miyokard koruması ve ameliyat sırası tedavi işlem-lerdeki ilerlemeler, kalp nakli yapılan hastalarda sağkalım oranlarını artırmaktadır. Tek başına donör iskemi süre-sine kıyasla, donör kalp koruması, ameliyat teknikleri ve alıcıların ameliyat öncesi durumunun kalp nakli sonrası mortalite üzerine daha önemli risk faktörü olduğu düşü-nülmektedir.Anah tar söz cük ler: Donör yaşı; donör iskemi süresi; kalp nakli.

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Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac transplantation

Abstract: Prolonged donor ischemic time is not a risk factor for decreased long-term survival. Procurement of hearts with prolonged donor ischemic time is justified in the setting of an increasing recipient pool with a fixed donor population.

Cited by 68 publications

References 19 publications

Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

Dopamine and Lipophilic Derivates Protect Cardiomyocytes against Cold Preservation Injury

The effect of donor ischemic time on mortality in heart transplanted patients

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