Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: A review of the literature

Abstract

Background Heart transplantation has become standard of care for pediatric patients with either end‐stage heart failure or inoperable congenital heart defects. Despite increasing surgical complexity and overall volume, however, annual transplant rates remain largely unchanged. Data demonstrating pediatric donor heart refusal rates of 50% suggest optimizing donor utilization is critical. This review evaluated the impact of donor characteristics surrounding the time of death on pediatric heart transplant recipient outcomes. Methods An extensive literature review was performed to identify articles focused on donor characteristics surrounding the time of death and their impact on pediatric heart transplant recipient outcomes. Results Potential pediatric heart transplant recipient institutions commonly receive data from seven different donor death‐related categories with which to determine organ acceptance: cause of death, need for CPR, serum troponin, inotrope exposure, projected donor ischemia time, electrocardiographic, and echocardiographic results. Although DITs up to 8 hours have been reported with comparable recipient outcomes, most data support minimizing this period to <4 hours. CVA as a cause of death may be associated with decreased recipient survival but is rare in the pediatric population. Otherwise, however, in the setting of an acceptable donor heart with a normal echocardiogram, none of the other data categories surrounding donor death negatively impact pediatric heart transplant recipient survival. Conclusions Echocardiographic evaluation is the most important donor clinical information following declaration of brain death provided to potential recipient institutions. Considering its relative importance, every effort should be made to allow direct image visualization.

Interplay between donor and recipient factors impacts outcomes after pediatric heart transplantation: An analysis from the united network for organ sharing database

“…In a recent review, McCulloch et al have suggested that keeping the ischemic time to less than 4 hours with an acknowledgement that factors other than the objective measure of time probably were important determinants of outcome. 3 In our study, the mortality at 1 year for prolonged IT group was slightly higher than the low-risk donor group. Prolonged IT group did have a significantly higher percentage of recipients who were post-congenital heart surgery which has been previously recognized as a risk factor for post-transplant mortality by itself.…”

“…[5][6][7] Similarly, the impact of reduced ejection fraction of the donor heart on graft survival is not completely clear, with studies supporting avoidance and use of reduced EF donors. 3 According to the current ISHLT statement, the effect on graft outcome does not seem to be additive when multiple risk factors were present in the same donor although this is not supported by evidence and does not translate into practice as evidenced by poor utilization of these high-risk donors. 1 Only 40% of donors with ≥1 risk factor are utilized compared to 80% with no risk factors.…”

“…2 Although donor IT up to 8 hours have been reported with comparable recipient outcomes, most data support minimizing this period to <4 hours. 3,4 Some studies have demonstrated comparable outcomes following heart transplantation with donor ITs greater than 4 hours, others have demonstrated increased early mortality. [5][6][7] Similarly, the impact of reduced ejection fraction of the donor heart on graft survival is not completely clear, with studies supporting avoidance and use of reduced EF donors.…”

A comprehensive strategy in donor acceptance: Impact on pediatric waitlist and heart transplant outcomes

“…The lack of established standards or guidelines for pediatric heart assessment and subsequent acceptance may limit donor utilization with direct impact on waitlist outcomes. To address some of these issues, our center's experience prompted the development of the ISHLT pediatric consensus guidelines and the suite of papers recently published in Pediatric Transplantation 9‐17 …”

A coordinated approach to improving pediatric heart transplant waitlist outcomes: A summary of the ACTION November 2019 waitlist outcomes committee meeting

“…Among those who do survive to transplant, waitlist characteristics, including waitlist duration, available mechanical support options, and renal injury all contribute to post‐transplant outcomes 3‐8 . The waitlist phase of care has received considerable attention recently, including the recent publication of an International Society for Heart & Lung Transplantation (ISHLT) consensus statement on donor organ acceptability and other important papers 9‐19 …”