A single‐center long‐term experience with marginal donor utilization for heart transplantation

Abstract

Background: To evaluate the early and late outcome of heart transplantation (HT) using marginal (MDs) and optimal donors (ODs). Methods: Clinical records of recipients transplanted between July 2004 and December 2014 were retrospectively reviewed. MDs were defined as follows: age >55 years, high-dose inotropic support, left ventricular ejection fraction <45%, left ventricular hypertrophy, donor to recipient predicted heart mass ratio <0.86, ischemic time >4 hours. Results: A total of 412 (55%) recipients received an organ from a MD; recipients who received an organ from an OD had less primary graft dysfunction (PGD) (25% vs 38%; P < .001), less acute renal failure (23% vs 34%; P < .001), and higher survival rates (90.2% vs 81.8% at 30 days, 79.5% vs 71.1% at 1 year, 51.8% vs 45.4% at 12 years; P = .01) than recipients who received an organ from a MD. There was no statistically significant difference in 30-day conditional survival between the two groups (survival rates 57.4% vs 55.5% at 12 years; P = .43). PGD, perioperative hemodialysis, and sepsis were independent risk factors of mortality at multivariate analysis. Conclusions: Utilization of MDs for HT is associated with a higher incidence of PGD and acute renal failure, and a reduction of 30-day survival.

Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation

“…2 In an attempt to resolve this problem, it is urged not only to promote organ donation but also to review the common regulation for donor organ selection criteria. [3][4][5] In the context of the deregulation of donor organ selection criteria, one of the global initiatives is to extend the existing donor pool by using so-called "marginal donor hearts," that is, organs that do not meet the entire range of criteria for optimal donor conditions. As a global consensus for alleviating donor heart criteria, the following donor selection factors were proposed: age, sex, or physique mismatch; drug abuse; hepatitis C; concomitant coronary artery disease; and impaired left ventricular (LV) function.…”

Trends in the utilization of marginal donors for orthotopic heart transplantation

“…Though we found that the use of a marginal donor was independently associated with post‐OHT mortality, prior studies have demonstrated relatively favorable outcomes with these donors 10,11 . Donor age in particular has been a focus of study.…”

Extended criteria donor organ use for heart-lung transplantation in the modern era

“…Donor hearts and lungs were determined to be ECD organs if they satisfied two ECD criteria ( Table 1 ). ECD criteria were adapted from the literature describing extended criteria in hearts [ 1 , 3 , 4 , 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] and lungs [ 2 , 6 , 7 , 8 , 17 ].…”