TY - JOUR
T1 - Increased sensitivity to ischemic interval of donor hearts with diminished left ventricular function
AU - Davila, Allison B.
AU - Shih, Wendy
AU - Stoletniy, Liset N.
AU - Martens, Tim P.
AU - Bailey, Leonard L.
AU - Razzouk, Anees J.
AU - Rabkin, David G.
N1 - Funding Information:
The authors have no conflicts of interest to disclose. The study content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the United States Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the United States Government. This work was supported in part by Health Resources and Services Administration (Contract No. 234-2005-37011C). This work was presented at the 38th annual meeting of the International Society for Heart and Lung Transplantation, April 2018, Nice, France.
Publisher Copyright:
© 2019 International Society for Heart and Lung Transplantation
PY - 2020/3
Y1 - 2020/3
N2 - Background: Previous studies have demonstrated that carefully selected donor hearts (DHs) with poor left ventricular ejection fraction (EF) may be transplanted with long-term survival equivalent to hearts with normal function. The purpose of this study is to facilitate their selection. Methods: Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Regression models were developed to estimate hazard ratios with 95% confidence intervals of post-transplant 1-year mortality and failure of EF to recover at 1 year for DHs with EF ≥50%, EF 40%–49.9%, and EF 30%–30.9%. Results: During the study period, 31,979 DHs were transplanted. Compared with DHs with left ventricular ejection fraction ≥50%, DHs with reduced EF were younger and had slightly lower body mass index. There were no differences in the mechanism of death between groups and no differences in recipient characteristics, except for a higher incidence of African American recipients of hearts with an EF of 40%–49.9%. Of the variables analyzed, only a 1-hour increase in ischemia time had different hazard ratios for 1-year mortality between groups, with increasing hazard as EF diminished. It was also the only variable that predicted failure of recovery of normal EF and that was in the lowest EF group. Conclusions: The impact of DH traits associated with adverse outcomes after heart transplantation that we studied are similar between DHs with EF <50% and those with EF ≥50%. However, limiting ischemic time may be even more important for DHs with diminished left ventricular function, particularly at the low end of the EF spectrum.
AB - Background: Previous studies have demonstrated that carefully selected donor hearts (DHs) with poor left ventricular ejection fraction (EF) may be transplanted with long-term survival equivalent to hearts with normal function. The purpose of this study is to facilitate their selection. Methods: Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Regression models were developed to estimate hazard ratios with 95% confidence intervals of post-transplant 1-year mortality and failure of EF to recover at 1 year for DHs with EF ≥50%, EF 40%–49.9%, and EF 30%–30.9%. Results: During the study period, 31,979 DHs were transplanted. Compared with DHs with left ventricular ejection fraction ≥50%, DHs with reduced EF were younger and had slightly lower body mass index. There were no differences in the mechanism of death between groups and no differences in recipient characteristics, except for a higher incidence of African American recipients of hearts with an EF of 40%–49.9%. Of the variables analyzed, only a 1-hour increase in ischemia time had different hazard ratios for 1-year mortality between groups, with increasing hazard as EF diminished. It was also the only variable that predicted failure of recovery of normal EF and that was in the lowest EF group. Conclusions: The impact of DH traits associated with adverse outcomes after heart transplantation that we studied are similar between DHs with EF <50% and those with EF ≥50%. However, limiting ischemic time may be even more important for DHs with diminished left ventricular function, particularly at the low end of the EF spectrum.
KW - donor heart selection
KW - heart transplantation
KW - ischemic interval
KW - ventricular function
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U2 - 10.1016/j.healun.2019.11.021
DO - 10.1016/j.healun.2019.11.021
M3 - Article
C2 - 31874793
SN - 1053-2498
VL - 39
SP - 241
EP - 247
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 3
ER -