Donor heart selection: Evidence-based guidelines for providers

Copeland, Hannah; Kneževič, Ivan; Baran, David A.; Rao, Vivek; Pham, Michael; Gustafsson, Finn; Pinney, Sean; Lima, Brian; Masetti, M.; Ciarka, Agnieska; Rajagopalan, Navin; Torres, Adriana Gisella; Hsich, Eileen; Patel, J.; Goldraich, Lívia Adams; Colvin, Monica; Segovia‐Cubero, Javier; Ross, Heather J.; Ginwalla, Mahazarin; Sharif-Kashani, Babak; Farr, Maryjane; Potena, Luciano; Kobashigawa, Jon A.; Crespo-Leiro, María G.; Altman, Natasha; Wagner, Florian; Cook, Jennifer; Stosor, Valentina; Grossi, Paolo; Khush, Kiran K.; Yağdı, Tahir; Restaino, Susan; Tsui, Steven; Absi, D.O.; Sokos, George; Zuckermann, Andreas; Wayda, Brian; Felius, Joost; Hall, Shelley

doi:10.1016/j.healun.2022.08.030

Cited by 45 publications

(26 citation statements)

References 393 publications

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“…Orthotopic heart transplantation (HTX) has been used as an optimal treatment for end-stage heart failure. Strict selection criteria and the application of score systems for the determination of urgency status on the waiting list have further aided in decreasing adverse outcomes [ 1 ]. Despite improvements in medical and device optimization in recent decades, heart transplantations still have a high complication rate, including primary graft dysfunction (PGD), early graft loss and rejection [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Pállinger

Székely

Töreki

et al. 2023

IJMS

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The proinflammatory cascade that is activated at the time of brain death plays a crucial role in organ procurement. Our aim of this study was to explore the relationship between the clinical outcome of orthotopic heart transplantation, as well as cytokine and apolipoprotein profiles of the pericardial fluid obtained at donation. Interleukin, adipokine and lipoprotein levels in the pericardial fluid, as well as clinical data of twenty donors after brain death, were investigated. Outcome variables included primary graft dysfunction, the need for posttransplantation mechanical cardiac support and International Society for Heart and Lung Transplantation grade ≥ 2R rejection. Hormone management and donor risk scores were also investigated. Lower levels of IL-6 were observed in primary graft dysfunction (median: 36.72 [IQR: 19.47–62.90] versus 183.67 [41.21–452.56]; p = 0.029) and in the need for mechanical cardiac support (44.12 [20.12–85.70] versus 247.13 [38.51–510.38]; p = 0.043). Rejection was associated with lower ApoAII (p = 0.021), ApoB100 (p = 0.032) and ApoM levels (p = 0.025). Lower adipsin levels were detected in those patients receiving desmopressin (p = 0.037); moreover, lower leptin levels were found in those patients receiving glucocorticoid therapy (p = 0.045), and higher T3 levels were found in those patients treated with L-thyroxine (p = 0.047) compared to those patients not receiving these hormone replacement therapies. IL-5 levels were significantly associated with UNOS-D score (p = 0.004), Heart Donor Score (HDS) and Adapted HDS (p < 0.001). The monitoring of immunological and metabolic changes in donors after brain death may help in the prediction of potential complications after heart transplantation, thus potentially optimizing donor heart allocation.

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Section: Introductionmentioning

confidence: 99%

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Pállinger

Székely

Töreki

et al. 2023

IJMS

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“…There is no strict cutoff for donor weight requirements, as it depends on the donor-to-recipient size matching. ISHLT guidelines recommend donor body weight no greater than 30% below that of the recipient if it is a same sex transplant, or no greater than 20% for a female to male transplant . In 2014, Reed et al proposed predicted heart mass (PHM) calculation using donor and recipient’s height, weight, age, and sex, and found PHM matching to better predict transplant outcomes compared with BMI, especially for female donor to male recipient cases …”

Section: Introductionmentioning

confidence: 99%

“…ISHLT guidelines recommend donor body weight no greater than 30% below that of the recipient if it is a same sex transplant, or no greater than 20% for a female to male transplant. 9,10 In 2014, Reed et al 11 proposed predicted heart mass (PHM) calculation using donor and recipient's height, weight, age, and sex, and found PHM matching to better predict transplant outcomes compared with BMI, especially for female donor to male recipient cases. 12 Higher pretransplant pulmonary vascular resistance (PVR) increases the risk of posttransplant graft dysfunction and failure.…”

Section: Introductionmentioning

confidence: 99%

Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

et al. 2023

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ImportancePretransplant obesity and higher pulmonary vascular resistance (PVR) are risk factors for death after heart transplant. However, it remains unclear whether appropriate donor-to-recipient size matching using predicted heart mass (PHM) is associated with lower risk.ObjectiveTo investigate the association of size matching using PHM with risk of death posttransplant among patients with obesity and/or higher PVR.Design, Setting, and ParticipantsAll adult patients (&gt;18 years) who underwent heart transplant between 2003 and 2022 with available information using the United Network for Organ Sharing cohort database. Multivariable Cox models and multivariable-adjusted spline curves were used to examine the risk of death posttransplant with PHM matching. Data were analyzed from October 2022 to March 2023.ExposureRecipient’s body mass index (BMI) in categories (&lt;18.0 [underweight], 18.1-24.9 [normal weight, reference], 25.0-29.9 [overweight], 30.0-34.9 [obese 1], 35-39.9 [obese 2], and ≥40.0 [obese 3]) and recipient’s pretransplant PVR in categories of less than 4 (29 061 participants), 4 to 6 (2842 participants), and more than 6 Wood units (968 participants); and less than 3 (24 950 participants), 3 to 5 (6115 participants), and 5 or more (1806 participants) Wood units.Main OutcomeAll-cause death posttransplant on follow-up.ResultsThe mean (SD) age of the cohort of 37 712 was 52.8 (12.8) years, 27 976 (74%) were male, 25 342 were non-Hispanic White (68.0%), 7664 were Black (20.4%), and 3139 were Hispanic or Latino (8.5%). A total of 12 413 recipients (32.9%) had a normal BMI, 13 849 (36.7%) had overweight, and 10 814 (28.7%) had obesity. On follow-up (median [IQR] 5.05 [0-19.4] years), 12 785 recipients (3046 female) died. For patients with normal weight, overweight, or obese 2, receiving a PHM-undermatched heart was associated with an increased risk of death (normal weight hazard ratio [HR], 1.20; 95% CI, 1.07-1.34; overweight HR, 1.12; 95% CI, 1.02-1.23; and obese 2 HR, 1.07; 95% CI, 1.01-1.14). Moreover, patients with higher pretransplant PVR who received an undermatched heart had a higher risk of death posttransplant in multivariable-adjusted spline curves in graded fashion until appropriately matched. In contrast, risk of death among patients receiving a PHM-overmatched heart did not differ from the appropriately matched group, including in recipients with an elevated pretransplant PVR.Conclusion and RelevanceIn this cohort study, undermatching donor-to-recipient size according to PHM was associated with higher posttransplant mortality, specifically in patients with normal weight, overweight, or class II obesity and in patients with elevated pretransplant PVR. Overmatching donor-to-recipient size was not associated with posttransplant survival.

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“…An MD heart does not meet all the standard criteria for heart donation but may still be considered for transplantation and are expected to have poor clinical outcomes. 2) The definition of MD varies among the authors, and Lee and colleagues defined MD based on the following criteria: donor age >55 years, left ventricular ejection fraction (LVEF) <50% on preoperative echocardiography, cold ischemic time >240 minutes, or significant cardiac structural problems on any imaging study. They investigated the outcomes of 73 patients who underwent heart transplantation of whom 43.8% received MD heart.…”

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confidence: 99%

To Take or Not to Take: The Dilemma With Marginal Donor Heart?

Park

2023

Korean Circ J

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Donor heart selection: Evidence-based guidelines for providers

Cited by 45 publications

References 393 publications

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation

Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

To Take or Not to Take: The Dilemma With Marginal Donor Heart?

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