Role of cardiovascular imaging in selection of donor hearts

“…It can be applied when a marginal donor is identified by a Transplant Coordination Center and selected by precise clinical and bedside echocardiography criteria. The first results of the project showed remarkable outcomes with a 1-year survival post-marginal heart transplant of 93% [17,44]. Stress echocardiography is proven to be an efficient tool to assess systolic and diastolic function, either in case of subclinical CAD, cardiomyopathy or stunned myocardium under hormonal treatment [22,45].…”

Section: Discussionmentioning

confidence: 99%

“…The EAE protocol for stress echo in this setting involves the use of dipyridamole, because of its steal phenomena through arteriolar vasodilation that does not involve catecholamines. Dobutamine is indicated only in cases of strong contraindications for dipyridamole because its effect could be detrimental by inducing direct myocardial injury and/or coronary vasospasm [22,44].…”

Section: Discussionmentioning

confidence: 99%

ADONHERS (Aged DONor HEart Rescue by Stress Echo) National Protocol: Recipient’s Survival after 10-Year Follow-Up

Mandoli

Barilli

Soviero

et al. 2023

JCM

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Background: The gold-standard treatment for end-stage heart failure is heart transplantation, but the lack of organ donors remains an important limitation in this field. An accurate selection of marginal hearts is fundamental to increase organ availability. Purpose: In our study we analyzed if recipients receiving marginal donor (MD) hearts, selected by dipyridamole stress echocardiography according to the ADOHERS national protocol, had different outcomes compared to recipients with acceptable donor (AD) hearts. Methods: Data were collected and retrospectively analyzed from patients who received an orthotopic heart transplant at our institution between 2006 and 2014. Dipyridamole stress echo was performed on identified marginal donors and selected hearts were eventually transplanted. Clinical, laboratory and instrumental features of the recipients were evaluated and patients with homogenous baseline characteristics were selected. Results: Eleven recipients transplanted with a selected marginal heart and eleven recipients transplanted with an acceptable heart were included. Mean donor age was 41 ± 23. The median follow-up was 113 months (IQR 86–146 months). Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two populations (p > 0.05). Left atrial size was significantly higher in patients with marginal hearts (acceptable atrial volume: 23 ± 5 mL; marginal atrial volume: 38 ± 5 mL; p = 0.003). Acceptable donor recipients showed a higher impact of Cardiac Allograph Vasculopathy (p = 0.019). No rejection differences were found between the two groups. Four patients deceased, three were standard donor recipients and one was from the marginal donor group. Conclusions: Our study shows how cardiac transplant (Htx) from selected marginal donor hearts through a non-invasive bedside technique can alleviate the shortage of organs without a difference in survival compared to acceptable donor hearts.

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“…Thorough examination of donor organs is also important. 19) Initially decreased donor heart function can be improved on follow-up echocardiography. If needed, coronary angiography might be considered.…”

Section: Discussionmentioning

confidence: 99%

Donor Heart Utilization in Korea

et al. 2020

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Background and Objectives Donor heart utilization patterns in Korea are not well known. We aimed to analyze the current utilization rate of donor heart and to evaluate the reason for non-utilization in Korea. Methods Brain death donors were identified from the Korean Network for Organ Sharing registry from November 2009 to December 2019. Baseline characteristics and heart transplant related parameters were compared between transplanted and discarded donor hearts. Results Among 4,401 donors, 1,383 (31.4%) hearts were utilized. Hearts from younger, male donors without history of hypertension or diabetes mellitus were utilized more frequently. The most common blood type in the transplanted group was O, while blood type A was the most common blood type in the discarded group. The ejection fraction in the discarded group were significantly lower (57.0 ± 13.5% vs. 61.7 ± 7.0%, p<0.001). Reasons for non-utilization were as follows: medical condition (34.4%), old age (31.8%), refused by all candidates (22.5%), refused to donate (11.0%), and others (0.2%). The most common cause of brain death was cerebrovascular disease in both the transplanted and discarded groups, but the incidence was significantly higher in the discarded group (46.8% vs. 37.5%, p<0.001). In multivariate analysis, old age, small body surface area, rapid heart rate, blood type other than O, abnormal echocardiography findings were independent predictors for non-utilization. Conclusions Average donor heart utilization rate was 31.4% and it improved to 42.9% in 2019. However, substantial numbers of donor hearts are still discarded. A strategic approach to improve donor heart utilization is necessary.

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Role of cardiovascular imaging in selection of donor hearts

Abstract: AIM:To perform a systematic review of literature on use of cardiovascular imaging in assessment of donor hearts.

Cited by 4 publications

References 34 publications

Donor heart selection: Evidence-based guidelines for providers

Donor heart selection: Evidence-based guidelines for providers

ADONHERS (Aged DONor HEart Rescue by Stress Echo) National Protocol: Recipient’s Survival after 10-Year Follow-Up

Donor Heart Utilization in Korea

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