Donor hypernatremia and smoking addiction contribute to primary graft failure in heart transplantation

Clinical Transplantation

et al. 2022

Background and aims Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation (HTx) and is correlated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium dysregulation on survival. This study aims to investigate the impact of donor sodium levels on early morbidity and short‐ and midterm survival following HTx. Methods Between September 2010 and June 2021, a total of n = 218 patients underwent HTx in our center. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut‐off levels from 145 to 159 mmol/L were investigated by Kaplan‐Meier‐analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133–145 mmol/L, n = 73), mild hypernatremia (146–156 mmol/L, n = 105) and severe hypernatremia (>156 mmol/L, n = 35). Recipient and donor variables were reviewed and compared, including peri‐ and postoperative characteristics and recipient survival after up to 5 years after transplantation. Results All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90‐day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (90% vs. 71%, p = .02), but not in mild hypernatremia (89%, p = .89). One‐year survival was comparable in all groups (p > .28). Conclusion Severe donor hypernatremia was associated with reduced short‐term survival, while the correlation weakens > 1 year after HTx. As our study is limited due to the nature of its retrospective, single‐center approach, future prospective studies are needed to evaluate the importance of donor management with regard to hypernatremia.

Section: Cut-off Values For Relevant Donor Hypernatremiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Donor hypernatremia is associated with increased mortality after heart transplantation: A retrospective study

Clinical Transplantation

et al. 2022

“…In general, the cut-off values for severity of hypernatremia range from >150 mmol/L [ 26 ] to >156 mmol/L [ 27 ]. Controversial and limited data exist regarding the impact of this donor sodium dysregulation in patient survival after solid organ transplantation, with cut-off levels for influence on survival ranging between 159 and 170 mmol/L [ 28 , 29 ]. Applying these cut-off levels to our cohort, those with a medium LOS in the ICU would be classified as mildly hypernatremic.…”

Section: Discussionmentioning

confidence: 99%

Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit

et al. 2022

Life

Prolonged treatment of organ donors in the intensive care unit (ICU) may be associated with complications influencing the outcome after heart transplantation (HTx). We therefore aim to explore the potential impact of the donor length of stay (LOS) in the ICU on outcomes in our cohort. We included all patients undergoing HTx in our center between September 2010 and April 2022 (n = 241). Recipients were divided around the median into three groups regarding their donor LOS in the ICU: 0 to 3 days (≤50th percentile, n = 92), 4 to 7 days (50th–75th percentile, n = 80), and ≥8 days (≥75th percentile, n = 69). Donor LOS in the ICU ranged between 0 and 155 days (median 4, IQR 3–8 days). No association between the LOS in the ICU and survival after HTx was observed (AUC for overall survival 0.514). Neither the Kaplan–Meier survival analysis up to 5 years after HTx (Log-Rank p = 0.789) nor group comparisons showed significant differences. Baseline recipient characteristics were comparable between the groups, while the donor baselines differed in some parameters, such as less cardiopulmonary resuscitation prior to HTx in those with a prolonged LOS. However, regarding the recipients’ peri- and postoperative parameters, the groups did not differ in all of the assessed parameters. Thus, in this retrospective analysis, although the donors differed in baseline parameters, the donor LOS in the ICU was not associated with altered recipient survival or outcome after HTx.

“…In general, cut-off values for hypernatremia severity range between >150 mmol/ [18] and >156 mmol/L [19]. There is controversial and limited data on the impact of donor sodium dysregulation on patient survival after solid organ transplantation, with cut-off values ranging from 159 to 170 mmol/L [20,21]. Therefore, in our cohort, those with high donor norepinephrine support have elevated but most likely not relevant mild hypernatremia without relevant influence on outcome or survival; however, this is limited obviously through the stated lack of data available on this topic.…”

Section: Discussionmentioning

confidence: 99%

Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients

et al. 2022

JCM

Objective: Although the application of higher doses of norepinephrine (NE) in potential organ donors is a frequent reason for heart decline, its associations with outcomes after heart transplantation (HTx) are discussed controversially. Therefore, we aimed to explore donor NE support’s potential impact on outcomes in our single-center heart transplant cohort. Methods: All patients who had undergone HTx in our center between September 2010 and April 2022 (n = 241) were screened for eligibility. From those, all patients with complete data on donor NE support (n = 238) were included. Recipients were divided into three groups according to their donor NE support: without support (n = 26), with low support of 0.01–0.2 µg/kg/min (n = 132), and with high support of > 0.2 µg/kg/min (n = 80). Receiver operating characteristics (ROC) and Kaplan Meier analysis was used to investigate the association of donor NE support and mortality after heart transplantation. Recipient and donor variables, including peri- and postoperative characteristics, were reviewed and compared. Results: NE support in donors ranged between 0 and 2.94 µg/kg/min (median 0.13 µg/kg/min, IQR 0.05–0.26 µg/kg/min). No association between donor NE support and mortality after HTx was observed (AUC for overall survival 0.494). Neither Kaplan-Meier analysis in survival up to 5 years after transplantation (Log Rank p = 0.284) nor group comparisons showed significant differences between the groups. With few exceptions, baseline characteristics in recipients and donors were comparable between the groups. Regarding peri- and postoperative parameters, increasing donor NE support was associated with a longer duration of mechanical ventilation (68 h and 95 h vs. 47 h), longer postoperative IMC/ICU stay (14 vs. 15 vs. 19 days), and a higher need for mechanical life support post-HTx (26% and 39% vs. 12%). Conclusion: In this retrospective analysis, NE support in donors prior to heart transplantation was unrelated to differing survival after heart transplantation. However, higher doses of donor NE were associated with prolonged ventilation, longer duration on IMC/ICU, and a higher need for extracorporeal life support in recipients post-HTx.