Donor scoring system for heart transplantation and the impact on patient survival

Smits, Jacqueline M.; Pauw, Michel De; Vries, Erwin de; Rahmel, Axel; Meiser, Bruno; Laufer, Guenther; Zuckermann, Andreas

doi:10.1016/j.healun.2011.11.005

Cited by 104 publications

(115 citation statements)

References 24 publications

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“…These included (1) donor age>50 years, 2, 10–12 (2) female sex, 13–17 (3) cerebrovascular accident/stroke as the cause of death, 12, 18–20 (4) hypertension, 11, 12 (5) diabetes, 10, 11 (6) history of cocaine or methamphetamine use, 21–23 (7) high inotrope requirement (dopamine>10 mcg/kg/min) during donor management, 10–12, 24 (8) cardiac troponin I >1.0 mcg/L, 25–27 (9) left ventricular dysfunction (defined as left ventricular ejection fraction<50%), 12, 28 (10) left ventricular regional wall motion abnormalities, 10 and (11) left ventricular hypertrophy (defined as septal or posterior wall thickness>1.1 cm). 6, 12, 29, 30 A cut-off of 1.0 mcg/L was used to define an elevated troponin level based on the knowledge that donor hospitals used a variety of assays from multiple manufacturers to perform this test, and reference values for a positive troponin level varied from 0.04–1.0 mcg/L depending on the specific assay used. We therefore selected the upper boundary to ensure specificity in capturing abnormal troponin values, albeit with a recognized loss of sensitivity.…”

Section: Methodsmentioning

confidence: 99%

Donor Predictors of Allograft Use and Recipient Outcomes After Heart Transplantation

Khush

Menza

Nguyen

et al. 2013

Circ: Heart Failure

136

151

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Background Despite a national organ donor shortage and a growing population of patients with end-stage heart disease, the acceptance rate of donor hearts for transplantation is low. We sought to identify donor predictors of allograft non-utilization, and to determine whether these predictors are in fact associated with adverse recipient post-transplant outcomes. Methods and Results We studied a cohort of 1,872 potential organ donors managed by the California Transplant Donor Network from 2001–2008. Forty five percent of available allografts were accepted for heart transplantation. Donor predictors of allograft non-utilization included age>50 years, female sex, death due to cerebrovascular accident, hypertension, diabetes, a positive troponin assay, left ventricular dysfunction and regional wall motion abnormalities, and left ventricular hypertrophy. For hearts that were transplanted, only donor cause of death was associated with prolonged recipient hospitalization post-transplant, and only donor diabetes was predictive of increased recipient mortality. Conclusions While there are many donor predictors of allograft discard in the current era, these characteristics appear to have little effect on recipient outcomes when the hearts are transplanted. Our results suggest that more liberal use of cardiac allografts with relative contraindications may be warranted.

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Section: Methodsmentioning

confidence: 99%

Donor Predictors of Allograft Use and Recipient Outcomes After Heart Transplantation

Khush

Menza

Nguyen

et al. 2013

Circ: Heart Failure

136

151

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“…According to the registry of the International Society for Heart and Lung Transplantation (ISHLT), 1‐year survival amounted to 84.5%, and 5‐year survival to 72.5% in 2014,2 with about 10% lower survival rates reported in Europe 3. Several models have been developed to predict survival after HTx based on pretransplant assessments, taking into account up to 43 demographic and medical recipient and donor variables,4, 5, 6 yet excluding psychosocial patient characteristics. The importance of the latter variables has been acknowledged by the ISHLT listing criteria for HTx, which focus primarily on screening for lack of social support in an effort to reduce the risk of adverse outcomes (Class I recommendation, Level of Evidence C) 7…”

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confidence: 99%

Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

Spaderna

Zittermann

Reichenspurner

et al. 2017

JAHA

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BackgroundWe evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients.Methods and ResultsBetween 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow‐up of 70 months (<1–93 months post‐HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1‐year/5‐year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).ConclusionsLow depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.

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“…8,14 Smits and associates 14 designed and validated a donor scoring system for heart transplantation using the Eurotransplant Registry. In this study, donor diabetes was not associated with increased recipient mortality.…”

Section: Discussionmentioning

confidence: 99%

“…9-13 Existing data on the use of hearts of diabetic donors, which otherwise fulfill standard criteria for donation, have been conflicting. 8,14 In this study, we attempt to determine whether adult cardiac transplantation can be safely performed using diabetic donors who otherwise fulfill standard criteria for organ donation according to the United Network for Organ Sharing (UNOS) database. We examined donor insulin dependence and duration of diabetes to determine whether these factors affected recipient survival.…”

mentioning

confidence: 99%

Cardiac transplantation can be safely performed using selected diabetic donors

Taghavi

Jayarajan

Wilson

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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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.

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Donor scoring system for heart transplantation and the impact on patient survival

Cited by 104 publications

References 24 publications

Donor Predictors of Allograft Use and Recipient Outcomes After Heart Transplantation

Donor Predictors of Allograft Use and Recipient Outcomes After Heart Transplantation

Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

Cardiac transplantation can be safely performed using selected diabetic donors

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