Medium-term outcome of recipients of marginal donor hearts selected with new stress-echocardiographic techniques over standard criteria

Abstract

BackgroundHeart transplantation is limited by severe donor organ shortage. Regardless of the changes made in the acceptance of marginal donors, any such mechanism cannot be considered successful unless recipient graft survival rates remain acceptable. A stress echo-driven selection of donors has proven successful in older donors with normal left ventricular resting function and in standard donors with reversible resting left ventricular dysfunction acutely improving during stress, or slowly improving (over hours) during intensive hormonal treatment. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected with new echocardiographic techniques over standard criteria.Methods and resultsWe enrolled 43 recipients of marginal donor hearts: age > 55 years, or < 55 years but with concomitant risk factors, n = 32; acutely improving during stress, n = 3; or slowly improving during hormonal treatment, n = 8. At follow-up (median, 30 months; interquartile range, 21–52 months), 37 of the recipients were still alive. One-year survival was 93%.ConclusionThe strict use of new stress-echocardiographic techniques over standard criteria of marginal donor management, together with comprehensive monitoring of the donor, has the potential to substantially increase the number of donor hearts without adverse effects on recipient medium-term outcome.

Donor selection in the modern era

“…If doubts persist, donor coronary angiography may be requested to rule out ischemic heart disease. Alternatively, Bombardini and colleagues have successfully used stress echocardiography to risk-stratify donors with left ventricular dysfunction-those that demonstrated improvement in systolic function with stress had excellent post-transplant outcomes (25), suggesting that this may be an attractive approach to identify donors with transient and reversible cardiac dysfunction.…”

Role of cardiovascular imaging in selection of donor hearts

“…As part of the Adonhers (aged donor heart rescue by stress echo) project 43 recipients who received "marginal" hearts and were older than 55 years of age or had concomitant risk factors were followed for 3 years. The outcomes in these recipients were unremarkable with a 1 year survival of 93% suggesting a role for stress echo screening of donor hearts to increase the donor pool [11] .…”

“…The pharmacological agents used currently are dipyridamole and dobutamine with the latter being less preferred due to high heart rates in the resting state in the donor hearts secondary to the high catecholamine state [11] .…”

Left ventricle myocardium hypertrophy of donor heart: the results and outlook

“…Данный метод позволил использовать донорские сердца от доноров до 65 лет с ненарушенной функцией ЛЖ в покое для ТС. Среднесрочный результат выживаемости реципиентов с сердечными трансплантатами от доноров старше 55 лет оказался аналогичным результату выживаемости реципиентов с сердечными трансплантатами от доноров со стандартными критериями [31].…”