Cardiac transplantation can be safely performed using selected diabetic donors

Abstract

Objective Cardiac transplantation (OHT) using diabetic donors (DDs) is thought to adversely influence survival. We attempt to determine if adult OHT can be safely performed using selected DDs. Methods The United Network for Organ Sharing (UNOS) database was examined for adult OHT from 2000 to 2010. Results Of the 20,348 patients undergoing OHT, 496 (2.4%) were with DDs. DDs were older (39.6 vs 31.3 years; P <.001), more likely female (41.5% vs 28.3%; P <.001), and had a higher body mass index (BMI) (29.9 vs 26.4; P <.001). Recipients of DD hearts were older (53.4 vs 51.8; P = .004) and more likely to have diabetes (18.9% vs 14.9%; P = .024). The 2 groups were evenly matched with regard to recipient male gender (78.0% vs 76.1%; P = .312), ischemic time (3.3 vs 3.2 hours; P = .191), human leukocyte antigen mismatches (4.7 vs 4.6; P = .483), and requirement of extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (0.8% vs 0.5%; P = .382). Median survival was similar (3799 vs 3798 days; P = .172). On multivariate analysis, DD was not associated with mortality (hazard ratio [HR], 1.155; 95% confidence interval [CI], 0.943-1.415; P = .164). As previously demonstrated, donor age, decreasing donor BMI, ischemic time, recipient creatinine, recipient black race, recipient diabetes, race mismatch, and mechanical ventilation or ECMO as a bridge to transplant were associated with mortality. On multivariate analysis of subgroups, neither insulin-dependent diabetes (1.173; 95% CI, 0.884-1.444; P = .268) nor duration of diabetes for more than 5 years (HR, 1.239; 95% CI, 0.914-1.016; P = .167) was associated with mortality. Conclusions OHT can be safely performed using selected DDs. Consensus criteria for acceptable cardiac donors can likely be revised to include selected DDs.

Cardiac transplantation for older patients: Characteristics and outcomes in the septuagenarian population

“…Outcomes were adjusted for select baseline characteristics of transplant recipient and donor, chosen a priori based on prior studies and clinical relevance. 8-10,13,14 Single imputation was used for missing values. Missing values for continuous variables were imputed to the median, and missing values for categorical variables were imputed to the most frequent category.…”

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

“…Currently, there is a paucity of data to help guide treatment in these patients, and previous research has been limited to small, single-institutional series. 1,2,4,17 The goal of this study was to use a large, national database to determine which types of NCSPs are required in patients supported with ECMO and to identify variables that influence outcomes in this group of patients.…”

Elevated donor hemoglobin A1c does not impair early survival in cardiac transplant recipients

“…The existing literature correlating the impact of donor glycemic status on recipient outcomes remains inconclusive . One small, retrospective, single‐institution study with 112 OHT recipients by Tsao and colleagues compared donor characteristics and their relation with recipient survival in OHT .…”

“…Unlike many characteristics for which the conclusion is relatively clear, the association of donor DM with recipient survival after OHT is unclear. The literature currently includes three retrospective reports on the topic: One study reports that the presence of donor DM negatively impacts recipient survival, while two others found no such association, including one that utilized the United Network for Organ Sharing (UNOS) registry. Additionally, all three of these studies utilize a historical diagnosis of DM, which yields a study group with significant heterogeneity with respect to glycemic control.…”