Marginal Cardiac Allografts Do Not Have Increased Primary Graft Dysfunction in Alternate List Transplantation

Abstract

Background-Clinical success with modern heart transplantation (HT) has led to the development of an alternate list (AL) HT strategy, matching marginal cardiac allografts with recipients who do not meet standard criteria for HT. Marginal allografts may be at an increased risk for primary graft dysfunction (PGD), the leading cause of early mortality after HT. 1 The incidence of PGD in AL HT relative to standard list (SL) HT has not been evaluated, and may contribute to the greater mortality associated with AL HT.2 The objective of this study was to determine the incidence of and predictors for PGD. Methods and Results-A retrospective analysis was performed on 260 consecutive adult patients undergoing either SL HT (nϭ207) or AL HT (nϭ53) at our institution from 1/2000 to 1/2005. PGD was defined by requirement for mechanical circulatory support immediately post-HT or more broadly as the need for either mechanical support or high-dose inotrope (epinephrine Ն0.07 g/kg/min). Donor hearts allocated to AL recipients were turned down for SL HT for reasons that included coronary disease, left ventricular dysfunction or hypertrophy, and high-dose inotropic requirement. AL HT recipients were significantly older, with a higher proportion of diabetes mellitus and ischemic cardiomyopathy. Both groups experienced a similar incidence of significant rejection, but overall mortality was higher in the AL HT group. 2 The incidence of PGD did not differ between AL and SL HT recipients. Pre-transplant VAD and prolonged total ischemic times (Ն4.5hours) were independent predictors of PGD. Conclusion-Select

Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Current donor and recipient criteria limit the use of hearts to donors who are within approximately 20% of the recipient's weight or a DR weight ratio of 0.8 to 1.2. Previous studies analyzing the impact of donor-to-recipient size have done so from an institutional perspective or as a subanalysis of a larger study.…”

“…1 Because of the donor organ deficit, efforts have been made to use marginal donors in an attempt to increase the donor organ pool and reduce waiting list mortality. [2][3][4][5][6][7] These attempts include the use of hearts from older donors 8 -11 and hearts that have been subjected to longer ischemic times, [12][13][14][15][16] both of which have led to conflicting results in the literature.…”

Successful Heart Transplantation Using a Donor Heart Afflicted by Takotsubo Cardiomyopathy

“…Similarly, in a Cleveland Clinic study of 50 donor hearts with >70 echocardiographic abnormalities (6), the vast majority exhibited normalized parameters following transplantation. When examining outcomes of "marginal donor hearts" in the alternative heart transplant program at Duke, we found no increased risk of subsequent graft dysfunction (7).…”

Successful Medication Therapy of Acute Right Ventricle Insufficiency in Recipient With Significant Pulmonary Hypertension After Heart Transplantation

“…Оно проявляется как тяжелая желу-дочковая дисфункция донорского трансплантата и приводит к высокой летальности, достигающей 10-20% [12,21]. Согласно данным Международ-ного регистра трансплантации сердца и легкого (ISHLT), первичная дисфункция трансплантата ос-тается единственной самой частой причиной смер-ти в течение первого месяца после ТС [24].…”