Use of hearts transplanted from donors with atraumatic intracranial bleeds

Marelli, Daniel; Tsai, Feng‐Chun; Laks, Hillel; Houston, Emma; Bresson, Jessica; Friend, Lauren; Gjertson, David W.; Sykes, Amelia; Ardehali, A.; Esmailian, F.; Hamilton, Michèle A.; Fonarow, Gregg C.; Moriguchi, J.; Plunkett, Mark; Hage, A.; Brown, Matthew S.; Mark, Manuel; Kobashigawa, Jon A.

doi:10.1016/s1053-2498(01)00425-9

Cited by 56 publications

(31 citation statements)

References 6 publications

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“…In a study of 27 patients whose hearts were systematically examined after an acute fatal episode of intracranial brain hemorrhage, Baroldi et al found evidence of myocardial necrosis in up to 89% of these patients as compared with only 4% in 45 cases of fatal head trauma (4). Increased donor age is another confounding factor in the donors who die from brain injury caused by intracranial bleeding (5). This may potentially contribute to the higher incidence of post-transplant ischemic injury complicated by fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Several experimental animal models have demonstrated impairment of myocardial function and hemodynamic performance after brain death (2)(3)(4). Atraumatic intracranial bleeding, which occurs in approximately 39% of brain death donors, has been found to be a potential independent risk factor for early mortality after cardiac transplantation (5). Although the exact causes of cardiac dysfunction after brain death remain unknown, one proposed pathophysiologic mechanism is the excessive catecholamine surge that accompanies the endocrine perturbations associated with intracranial bleeding (2)(3)(4)(6)(7)(8).…”

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confidence: 99%

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Impact of Donor Spontaneous Intracranial Hemorrhage on Outcome after Heart Transplantation

Yamani

Lauer

Starling

et al. 2004

American Journal of Transplantation

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Donor cause of death has been suggested to have a significant impact on cardiac transplant morbidity and mortality. Our objective was to evaluate the impact of donor spontaneous intracranial bleeding on clinical outcome after heart transplantation. A group of 160 recipients underwent cardiac transplantation from donors with spontaneous intracranial bleeding (ICB group). These were compared with 197 recipients who were transplanted from trauma donors (Trauma group). A higher 4-year mortality rate was noted in the ICB group (24% vs. 14%, p = = 0.015). ICB as a cause of donor death was an independent predictor of recipient mortality (adjusted hazard ratio 2.02, 95% CI 1.27-3.40, p < 0.0001). Compared with the Trauma group, the ICB group had an increased incidence of post-transplant graft dysfunction during the first week of transplant (10% vs. 3%, p = = 0.007), and higher incidence of interstitial myocardial fibrosis on their endomyocardial biopsies within 4 weeks of transplant (21% vs. 9%, p = = 0.0012). There was a trend towards an increased rate of allograft vasculopathy in the ICB group (competing risks adjusted hazard ratio 1.39, 95% CI 0.90-2.13, p = = 0.14).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of Donor Spontaneous Intracranial Hemorrhage on Outcome after Heart Transplantation

Yamani

Lauer

Starling

et al. 2004

American Journal of Transplantation

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“…1,12 We have observed that the donor cause of death was more likely to be brain injury-related in patients who develop myocardial ischemic injury/interstitial fibrosis after transplantation. 13 We have also shown that myocardial ischemic injury after cardiac transplantation is associated with activation of the MMP induction system.…”

Section: Discussionmentioning

confidence: 99%

“…1 Heart transplant recipients from donors with ICH are at increased risk of allograft vasculopathy. 1 Activation of sympathetic nervous system activity and excessive catecholamine surge are among the proposed mechanisms underlying graft dysfunction and vasculopathy in donors with ICH. 2 Matrix metalloproteinases (MMPs) are an endogenous family of zinc-dependent enzymes, responsible for matrix remodeling in several disease states.…”

mentioning

confidence: 99%

Donor Spontaneous Intracerebral Hemorrhage Is Associated With Systemic Activation of Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 and Subsequent Development of Coronary Vasculopathy in the Heart Transplant Recipient

et al. 2003

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Background-Matrix metalloproteinase (MMP)-2 and MMP-9 have been shown to play a role in the progression of hemorrhagic stroke. We hypothesized that donor intracerebral hemorrhage (ICH) is associated with activation of the metalloproteinases before transplantation that play a key role in the subsequent development of transplant vasculopathy. Methods and Results-We evaluated mRNA expressions of MMP-2 and MMP-9 in donor spleen lymphocytes (before transplantation) and in heart biopsies at 1 week after transplantation in 20 recipients from ICH donors and 20 recipients from trauma donors. Patients underwent serial coronary intravascular ultrasound, and interstitial myocardial fibrosis was quantified at 1 year. The baseline characteristics were similar except for increased donor age in the ICH group. Heart biopsies from the ICH group showed significant increased expression of MMP-2 (17-fold, PϽ0.0001) and MMP-9 (20-fold, PϽ0.0001) compared with the trauma group. Furthermore, the ICH group showed 1.8-fold (Pϭ0.016) increased mRNA expression of MMP-2 and 1.7-fold (Pϭ0.015) increased mRNA expression of MMP-9 in the donor spleen lymphocytes, suggesting the presence of systemic activation of metalloproteinases before transplantation. At 1 year, the ICH group showed increased myocardial fibrosis and accelerated coronary vasculopathy. Using multivariate regression analysis, MMP-9 was found to be associated with increased risk for vasculopathy independent of donor age (OR, 2.41; Pϭ0.01; 95% CI, 1.24 to 4.69). Conclusions-This is the first report to describe systemic activation of MMP-2 and MMP-9 in donors with intracerebral hemorrhage and subsequent development of allograft vasculopathy.

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“…Durch optimales Spendermanagement kann nach Abklingen des Sympathikussturms die myokardialen Erholung eintreten, da die hirntodassoziierten Veränderungen prinzipiell reversibel sind. Damit wird bei einem ursprünglich inakzeptablen Spender das Risiko deulich gesenkt [8,23].…”

Section: Todesursache/-umständeunclassified

Evaluation of the potential organ donor with special regards to heart donation

Höfer

Aliabadi

Ebner

et al. 2010

Wien Klin Wochenschr

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Regarding limited availability of organ donors for heart transplantation, it is necessary to discuss optimal donor evaluation and donor management. In this manuscript general donor-related parameters as well as heart-specific parameters are discussed regarding international literature. In addition, "marginal" donors and in contrast "optimal" donors are defined. Donor management including optimal hemodynamic management and additional specific intensive care aspects are presented. Exact donor evaluation allows for matching the organ to the most suitable recipient and is therefore especially in the context of marginal donors a crucial step within transplantation process.

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Use of hearts transplanted from donors with atraumatic intracranial bleeds

Cited by 56 publications

References 6 publications

Impact of Donor Spontaneous Intracranial Hemorrhage on Outcome after Heart Transplantation

Impact of Donor Spontaneous Intracranial Hemorrhage on Outcome after Heart Transplantation

Donor Spontaneous Intracerebral Hemorrhage Is Associated With Systemic Activation of Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 and Subsequent Development of Coronary Vasculopathy in the Heart Transplant Recipient

Evaluation of the potential organ donor with special regards to heart donation

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