Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit

Abstract

Background: In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD). Methods: All patients who underwent HTx between January 2012 and December 2020 were enrolled at a single institution. The primary endpoints were early and long-term survival of MD recipients. Risk factors for primary graft failure (PGF) and mortality in MD recipients were also analyzed. The secondary endpoint was the comparison of survival of MD versus SD recipients. Results: In total, 238 patients underwent HTx, 64 (26.9%) of whom received an organ from an MD. Hospital mortality in the MD recipient cohort was 23%, with an estimated 1 and 5-year survival of 70% (59.2–82.7) and 68.1% (57.1–81), respectively. A multivariate analysis in MD recipients showed that decreased renal function and increased inotropic support of recipients were associated with higher mortality (p = 0.04 and p = 0.03). Cold ischemic time (p = 0.03) and increased donor inotropic support (p = 0.04) were independent risk factors for PGF. Overall survival was higher in SD than MD (85% vs. 68% at 5 years, log-rank = 0.008). However, risk-adjusted mortality (p = 0.2) and 5-year conditional survival (log-rank = 0.6) were comparable. Conclusions: Selected MDs are a valuable resource for expanding the cardiac donor pool, showing promising results. The use of MDs after prolonged ischemic times, increased inotropic support of the MD or the recipient and decreased renal function are associated with worse outcomes.

Heart transplantation in the era of corona virus disease 2019: Impact of the pandemic on donors, recipients and outcome

“…Although those donors have been called marginal in the past, there are many recent studies confirming the good outcome of HTx with those donors. 3,[16][17][18][19] ISHLT registry data show that likewise with our centre's policy, acceptance of those donors has become frequent practice worldwide to increase the donor pool. 3 We reported shorter warm ischemia for the Group 2 than Group 1.…”

“…Same trends were found for concomitant diabetes mellitus of donors as well as drug abuse. Although those donors have been called marginal in the past, there are many recent studies confirming the good outcome of HTx with those donors 3,16–19 . ISHLT registry data show that likewise with our centre's policy, acceptance of those donors has become frequent practice worldwide to increase the donor pool 3 …”

The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

“… 11) Although donors ineligible for these conditions may be classified as an MD, the specific criteria differ from one center to another, depending on the experiences of each center ( Supplementary Table 4 ). 12) 13) 14) 15) 16) 17) 18) In an effort to guide clinicians, an integrative scoring system was suggested based on UNOS data. 19) Predictive risk models have been developed to optimize donor selection; however, they are not widely applicable or adopted in clinical practice.…”

A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience

“…Additionally, in our experience a BTT patient has a 40% probability to be transplanted at 12 months, reaching over 62% at 24 months [ 6 , 8 ]. Limiting the waiting list time for transplantation results in a lower incidence of adverse events [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Our strategy allows this subgroup group of patients to benefit from excellent survival and to be in optimal condition for transplantation [ 25 ].…”