Donor risk analysis and validation in heart transplants: a single-centre experience

Abstract

OBJECTIVES A heart transplant (Htx) remains the gold standard treatment for patients with advanced heart failure. Considering the limited availability of organs, donor risk scores might improve organ selection and allocation. The objective of the study was to compare United Network for Organ Sharing, RADIAL and Eurotransplant scoring models in calculating post-Htx outcomes in an Italian Htx population. METHODS Between January 2000 and December 2017, a total of 461 adult patients underwent Htxs. United Network for Organ Sharing, RADIAL and Eurotransplant scores were calculated. Clinical features and donor risk scores were tested to identify preoperative, intraoperative and postoperative risk variables and eventually validate the scores on our population. RESULTS Early graft failure was detected in 16.1% (74/461). Post-Htx extracorporeal life support was used in 11.1% (51/461). Of the donor-related factors, the use of noradrenaline (P = 0.015) negatively influenced early outcomes, whereas an ischaemic time >240 min (P = 0.037) influenced early graft failure occurrence. The Eurotransplant donor score did not impact outcomes; the RADIAL score significantly influenced both early and late mortality; and the United Network for Organ Sharing score influenced only late mortality. On the multivariable analysis, after adjustment of scores per cohort, noradrenaline infusion was the main independent predictor of in-hospital mortality for the donors, whereas age of the recipient [odds ratio (OR) 1.003, 1.003–1.081; P = 0.032] and use of preoperative extracorporeal membrane oxygenation (OR 3.320, 1.124–9.805; P = 0.030) were the main independent predictors for the recipients. CONCLUSIONS None of the validated donor scoring systems fully behave as reliable predictors of transplant outcomes. According to our ‘local only’ graft selection, specific donor and recipient risk variables should be monitored in order to predict early and late outcomes satisfactorily.

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

“…However, often only information on donors with <0.1 µg/kg/min is available, while the percentage of those without any support is missing. Zuckermann et al reported in a large cohort dataset from the Eurotransplant area that around 58% of all recipients had donors with ≥0.1 µg/kg/min noradrenaline support prior to transplantation [9], while others reported rates of approximately 53-60% [7,8]. In our study cohort, 55% of all patients (n = 131) had support ≥0.1 µg/kg/min, which was also in the reported range of previous studies.…”

“…Compared to the literature, 30-day survival in our cohort (ranging from 89-92%) was comparable to larger HTx-cohorts (89-93% [5,6]), and equal 30-day and 1-year survival distribution between all three groups could be seen. The influence of donor noradrenaline usage and their respective levels on recipient survival after heart transplantation remains controversial in the published literature, and only a few studies explicitly analyze this parameter [7][8][9]. While Murana et al suggest an impact on recipient in-hospital mortality survival [8], this could not be validated in both data from cohort studies by Benck et al [10] as well as Kutschmann et al [11].…”

“…The influence of donor noradrenaline usage and their respective levels on recipient survival after heart transplantation remains controversial in the published literature, and only a few studies explicitly analyze this parameter [7][8][9]. While Murana et al suggest an impact on recipient in-hospital mortality survival [8], this could not be validated in both data from cohort studies by Benck et al [10] as well as Kutschmann et al [11]. Interestingly, in a larger study by Angleitner et al [12], no effect on early survival of recipients could be observed, even in exceptionally high donor noradrenaline levels (>0.4 µg/kg/min).…”

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

“…Additionally, in general, the average ICU LOS independent from the underlying disease is 3.3 days [ 21 ], matching the donor LOS in our cohort. However, larger cohort data are unavailable because most authors, even in papers focusing on heart transplant donor parameters, do not report the donor ICU LOS [ 2 , 22 , 23 ]. Of note, in a recent study by D’Aragon et al investigating overall donor characteristics in Canada (DONATE cohort study [ 24 ]), donors with the neurological determination of death (donation after brain dead; DBD) had shorter LOS in the ICU prior to solid organ donation than those with the circulatory determination of death (DCD, 1.6 vs. 3.8 days).…”

“…The effect of donor parameters on outcome and survival after heart transplantation is crucial and is currently one of the most essential topics of organ acceptance [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. A potential donor risk factor for organ quality is the donor length of stay (LOS) in the ICU.…”