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Schroder JN, Patel CB, DeVore AD, Casalinova S, Koomalsingh KJ, Shah AS, Anyanwu AC, D'Alessandro DA, Mudy K, Sun B, Strueber M, Khaghani A, Shudo Y, Esmailian F, Liao K, Pagani FD, Silvestry S, Wang IW, Salerno CT, Absi TS, Madsen JC, Mancini D, Fiedler AG, Milano CA, Smith JW. Increasing Utilization of Extended Criteria Donor Hearts for Transplantation: The OCS Heart EXPAND Trial. JACC. HEART FAILURE 2024; 12:438-447. [PMID: 38276933 DOI: 10.1016/j.jchf.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Extended criteria donor (ECD) hearts available with donation after brain death (DBD) are underutilized for transplantation due to limitations of cold storage. OBJECTIVES This study evaluated use of an extracorporeal perfusion system on donor heart utilization and post-transplant outcomes in ECD DBD hearts. METHODS In this prospective, single-arm, multicenter study, adult heart transplant recipients received ECD hearts using an extracorporeal perfusion system if hearts met study criteria. The primary outcome was a composite of 30-day survival and absence of severe primary graft dysfunction (PGD). Secondary outcomes were donor heart utilization rate, 30-day survival, and incidence of severe PGD. The safety outcome was the mean number of heart graft-related serious adverse events within 30 days. Additional outcomes included survival through 2 years benchmarked to concurrent nonrandomized control subjects. RESULTS A total of 173 ECD DBD hearts were perfused; 150 (87%) were successfully transplanted; 23 (13%) did not meet study transplantation criteria. At 30 days, 92% of patients had survived and had no severe PGD. The 30-day survival was 97%, and the incidence of severe PGD was 6.7%. The mean number of heart graft-related serious adverse events within 30 days was 0.17 (95% CI: 0.11-0.23). Patient survival was 93%, 89%, and 86% at 6, 12, and 24 months, respectively, and was comparable with concurrent nonrandomized control subjects. CONCLUSIONS Use of an extracorporeal perfusion system resulted in successfully transplanting 87% of donor hearts with excellent patient survival to 2 years post-transplant and low rates of severe PGD. The ability to safely use ECD DBD hearts could substantially increase the number of heart transplants and expand access to patients in need. (International EXPAND Heart Pivotal Trial [EXPANDHeart]; NCT02323321; Heart EXPAND Continued Access Protocol; NCT03835754).
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Affiliation(s)
| | | | - Adam D DeVore
- Duke University Hospital, Durham, North Carolina, USA
| | | | | | - Ashish S Shah
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Karol Mudy
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Benjamin Sun
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - Yasuhiro Shudo
- Stanford University Medical Center, Stanford, California, USA
| | | | | | | | | | - I-Wen Wang
- Memorial Healthcare System, Hollywood, Florida, USA
| | | | - Tarek S Absi
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joren C Madsen
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Donna Mancini
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy G Fiedler
- University of California-San Francisco, San Francisco, California, USA
| | | | - Jason W Smith
- University of California-San Francisco, San Francisco, California, USA
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Tetteh HA, Brandenhoff P, Higgins RS. Specialized Thoracic Adapted Recovery Model for Thoracic Organ Recovery: a 15-Year Review. Transplant Proc 2023; 55:384-386. [PMID: 36914437 DOI: 10.1016/j.transproceed.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND To review outcomes from a regionalized heart and lung transplant service over a 15-year period. METHODS Data on organ procurements made by the Specialized Thoracic Adapted Recovery (STAR) team. The STAR team staff recorded data from November 2, 2004 to June 30, 2020, were reviewed. RESULTS The STAR teams recovered thoracic organs from 1118 donors between November 2004 and June 2020. The teams recovered 978 hearts, 823 bilateral lungs, 89 right lungs and 92 left lungs, and 8 heart and lung sets. A total of 79% of hearts and 76.1% of lungs were transplanted, whereas 2.5% of hearts and 5.1% of lungs were declined; the remainder were used for research, valves, or abandoned. A total of 47 transplantation centers received at least 1 heart, and 37 centers received at least 1 lung during this period. The 24-hour graft survival among organs recovered by STAR teams was 100% for lungs and 99% for hearts. CONCLUSIONS A specialized regional thoracic organ procurement team may improve transplantation rates.
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Affiliation(s)
- H A Tetteh
- Department of Surgery, Uniformed Services University, Bethesda, Maryland.
| | - P Brandenhoff
- Cardiothoracic Surgery, Thoracic Transplant Consultants, San Francisco, California
| | - R S Higgins
- Department of Surgery, Mass General Brigham, Boston, Massachusetts
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3
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Current status of adult cardiac surgery-part 2. Curr Probl Surg 2023; 60:101245. [PMID: 36642488 DOI: 10.1016/j.cpsurg.2022.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/13/2022] [Indexed: 12/13/2022]
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Kim ST, Hadaya J, Tran Z, Iyengar A, Williamson CG, Rabkin D, Benharash P. Association of donor hypertension and outcomes in orthotopic heart transplantation. Clin Transplant 2021; 35:e14484. [PMID: 34515371 DOI: 10.1111/ctr.14484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/15/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
The present study examined the impact of donor hypertension on recipient survival and offer acceptance practices in the United States. This was a retrospective study of all patients undergoing OHT from 1995 to 2019 using the United Network for Organ Sharing and Potential Transplant Recipient file databases. Hypertensive donors were stratified by Short (0-5 years) and Prolonged (> 5 years) hypertension. Multivariable logistic regression was used to analyze offer acceptance practices while Cox proportional-hazards models were used to compare mortality across groups. Of 38,338 heart transplants meeting study criteria, 5662 were procured from hypertensive donors (69% Short and 31% Prolonged). After adjustment, Prolonged donor hypertension was associated with increased mortality (hazard ratio, HR, 1.31, 95% confidence interval, CI, 1.04-1.64), while recipients of Short donors experienced no decrement in post-transplant survival. Both Short and Prolonged hypertension were independently associated with decreased odds of offer acceptance (odds ratio, OR .92 95%CI: .88-.96 and OR .93 95%CI: .88-.99, respectively). While prolonged untreated hypertension in OHT donors is associated with a slight decrement in recipient survival, donors with ≤5 years of hypertension yielded similar outcomes. Donor hypertension was associated with reduced organ offer acceptance, highlighting a potential source of organ underutilization.
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Affiliation(s)
- Samuel T Kim
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine University of California, Los Angeles, California, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine University of California, Los Angeles, California, USA
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine University of California, Los Angeles, California, USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine G Williamson
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine University of California, Los Angeles, California, USA
| | - David Rabkin
- Department of Cardiovascular and Thoracic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine University of California, Los Angeles, California, USA
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Cardiac MicroRNA Expression Profile After Experimental Brain Death Is Associated With Myocardial Dysfunction and Can Be Modulated by Hypertonic Saline. Transplantation 2021; 106:289-298. [PMID: 33859149 DOI: 10.1097/tp.0000000000003779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brain death (BD) is associated with systemic inflammatory compromise, which might affect the quality of the transplanted organs. This study investigated the expression profile of cardiac microRNAs (miRNAs) after BD, and their relationship with the observed decline in myocardial function and with the changes induced by hypertonic saline solution (HSS) treatment. METHODS Wistar rats were assigned to sham-operation (SHAM) or submitted to BD with and without the administration of HSS. Cardiac function was assessed for 6h with left ventricular (LV) pressure-volume analysis. We screened 641 rodent miRNAs to identify differentially expressed miRNAs (DEMs) in the heart and computational and functional analysis were performed to compare the DEMs and find their putative targets and their related enriched canonical pathways. RESULTS An enhanced expression in canonical pathways related to inflammation and myocardial apoptosis was observed in BD induced group, with two miRNAs, miR-30a-3p and miR-467f, correlating with the level of LV dysfunction observed after BD. Conversely, HSS treated after BD and SHAM groups showed similar enriched pathways related to the maintenance of heart homeostasis regulation, in agreement with the observation that both groups did not have significant changes in LV function. CONCLUSIONS These findings highlight the potential of miRNAs as biomarkers for assessing damage in BD donor hearts and to monitor the changes induced by therapeutic measures like HSS, opening a perspective to improve graft quality and to better understand the pathophysiology of BD. The possible relation of BD induced miRNA's on early and late cardiac allograft function must be investigated.Supplemental Visual Abstract; http://links.lww.com/TP/C210.
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Angleitner P, Kaider A, Smits JM, Aliabadi-Zuckermann AZ, Osorio-Jaramillo E, Laufer G, Zuckermann AO. The adapted Heart Donor Score. Transpl Int 2021; 34:546-560. [PMID: 33455049 PMCID: PMC7986732 DOI: 10.1111/tri.13822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/29/2020] [Accepted: 01/14/2021] [Indexed: 02/03/2023]
Abstract
The Heart Donor Score (HDS) predicts donor organ discard for medical reasons and survival after heart transplantation (HTX) in the Eurotransplant allocation system. Our aim was to adapt the HDS for application in the United Network for Organ Sharing (UNOS) registry. To adjust for differences between the Eurotransplant and UNOS registries, the "adapted HDS" was created (aHDS) by exclusion of the covariates "valve function," "left-ventricular hypertrophy," and exclusion of "drug abuse" from the variable "compromised history." Two datasets were analyzed to evaluate associations of the aHDS with donor organ discard (n = 70 948) and survival (n = 19 279). The aHDS was significantly associated with donor organ discard [odds ratio 2.72, 95% confidence interval (CI) 2.68-2.76, P < 0.001; c-statistic: 0.937). The score performed comparably in donors <60 and ≥60 years of age. The aHDS was a significant predictor of survival as evaluated by univariate Cox proportional hazards analysis (hazard ratio 1.04, 95% CI 1.01-1.07, P = 0.023), although the association lost significance in a multivariable model. The aHDS predicts donor organ discard. Negative effects of most aHDS components on survival are likely eliminated by highly accurate donor selection processes.
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Affiliation(s)
- Philipp Angleitner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | | | | | | | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Witer L, Kilic A. Commentary: Proceed with caution: Right ventricular undersizing in heart transplant. J Thorac Cardiovasc Surg 2020; 161:1060-1061. [PMID: 33422319 DOI: 10.1016/j.jtcvs.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Lucas Witer
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Arman Kilic
- Division of Cardiac Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pa.
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8
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Lander MM. Thyroid hormone in cardiac transplantation: Cat chasing its tail? J Heart Lung Transplant 2020; 39:1079-1080. [PMID: 32771441 DOI: 10.1016/j.healun.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Matthew M Lander
- Department of Cardiovascular Medicine, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
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Atik FA, Oliveira FBM, Peres PHM, Moraes CS, Ulhoa MB, Biondi R, Barzilai VS, Chaves RB, Cunha CR. Is shortage of heart donors a real problem? Insights from a Brazilian Mid‐West heart transplant program. J Card Surg 2020; 35:1802-1810. [DOI: 10.1111/jocs.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Fernando A. Atik
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Felipe B. M. Oliveira
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Pedro H. M. Peres
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Camila S. Moraes
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Marcelo B. Ulhoa
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Rodrigo Biondi
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Vitor S. Barzilai
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Renato B. Chaves
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Claudio R. Cunha
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
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Swanson EA, Adams T, Patel MS, De La Cruz S, Hutchens M, Khush K, Sally MB, Niemann CU, Groat T, Malinoski DJ. Impact of Deceased Donor Management on Donor Heart Use and Recipient Graft Survival. J Am Coll Surg 2020; 231:351-360.e5. [PMID: 32562768 DOI: 10.1016/j.jamcollsurg.2020.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Current risk-adjusted models used to predict donor heart use and cardiac graft survival from organ donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between donor management and transplantation outcomes. STUDY DESIGN We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during donor management. The primary outcomes measures were donor heart use and cardiac graft survival. RESULTS From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included donor age (OR 0.94), BMI > 30 kg/m2 (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h). CONCLUSIONS Modifiable critical care parameters and treatments predict donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.
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Affiliation(s)
- Elizabeth A Swanson
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR
| | - Tony Adams
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, OR
| | - Madhukar S Patel
- Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | | - Michael Hutchens
- Operative Care Division, Section of Surgical Critical Care, Veterans Affairs Portland Health Care System, Portland, OR
| | - Kiran Khush
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford
| | - Mitchell B Sally
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR; Operative Care Division, Section of Surgical Critical Care, Veterans Affairs Portland Health Care System, Portland, OR
| | - Claus U Niemann
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA; Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Tahnee Groat
- Operative Care Division, Section of Surgical Critical Care, Veterans Affairs Portland Health Care System, Portland, OR
| | - Darren J Malinoski
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR; Operative Care Division, Section of Surgical Critical Care, Veterans Affairs Portland Health Care System, Portland, OR.
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11
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Khush KK, Ball RL. Great variability in donor heart acceptance practices across the United States. Am J Transplant 2020; 20:1582-1596. [PMID: 31883229 PMCID: PMC7261633 DOI: 10.1111/ajt.15760] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
Disparities in organ acceptance practices exacerbate donor heart nonuse and lead to increased waiting times and mortality for heart transplant candidates. We studied disparities in donor heart acceptance among US transplant centers and their relations to posttransplant outcomes. Candidate, potential transplant recipient match run, and deceased donor data were obtained from the United Network for Organ Sharing. We analyzed donor, candidate, and transplant center characteristics with respect to organ acceptance, offer acceptance, number of offers before acceptance (organ sequence number), and association with posttransplant mortality. A total of 693 420 donor heart offers made between April 2007 and December 2015 were included. We identified great variability in donor heart acceptance practices among US heart transplant centers. We identified donor and recipient characteristics that were strongly associated with heart organ and offer acceptance, and organ sequence number, and identified inconsistencies among centers with respect to how these characteristics influenced acceptance decisions. Finally, we identified characteristics that were highly predictive of donor heart nonuse and were not associated with increased recipient mortality, which may guide future efforts aimed at increasing use of available hearts for transplantation.
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Affiliation(s)
- Kiran K. Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Robyn L. Ball
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California
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Schweiger M, Everitt MD, Chen S, Nandi D, Castro J, Gupta D, Scheel J, Lal AK, Ablonczy L, Kirk R, Miera O, Davies RR, Dipchand AI. Review of the discard and/or refusal rate of offered donor hearts to pediatric waitlisted candidates. Pediatr Transplant 2020; 24:e13674. [PMID: 32198804 DOI: 10.1111/petr.13674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
Abstract
We aimed to review current literature on the discard rate of donor hearts offered to pediatric recipients and assess geographical differences. Consequences and ways to reduce the discard rate are discussed. A systemic review on published literature on pediatric transplantation published in English since 2010 was undertaken. Additionally, a survey was sent to international OPOs with the goal of incorporating responses from around the world providing a more global picture. Based on the literature review and survey, there is a remarkably wide range of discard and/or refusal for pediatric hearts offered for transplant, ranging between 18% and 57% with great geographic variation. The data suggest that that the overall refusal rate may have decreased over the last decade. Reasons for organ discard were difficult to identify from the available data. Although the refusal rate of pediatric donor hearts seems to be lower compared to that reported in adults, it is still as high as 57% with geographic variation.
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Affiliation(s)
- Martin Schweiger
- Division of Cardiac Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Bucaramanga City, Colombia
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Janet Scheel
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Laszlo Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Donor Heart Utilization in Korea. INTERNATIONAL JOURNAL OF HEART FAILURE 2020; 2:254-263. [PMID: 36262172 PMCID: PMC9536728 DOI: 10.36628/ijhf.2020.0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022]
Abstract
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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Magalhães DMS, Zanoni FL, Correia CJ, Simas R, Soares RGF, Sannomiya P, Moreira LFP. Hypertonic Saline Modulates Heart Function and Myocardial Inflammatory Alterations in Brain-Dead Rats. J Surg Res 2019; 235:8-15. [DOI: 10.1016/j.jss.2018.09.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/05/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022]
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15
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Beaupré RA, Morgan JA. Donation After Cardiac Death: A Necessary Expansion for Heart Transplantation. Semin Thorac Cardiovasc Surg 2019; 31:721-725. [DOI: 10.1053/j.semtcvs.2019.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/13/2019] [Indexed: 12/11/2022]
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Ising MS, Gallo M, Whited WM, Slaughter MS, Trivedi JR. Changing demographics of heart donors: The impact of donor drug intoxication on posttransplant survival. Am J Transplant 2018; 18:1790-1798. [PMID: 29513379 DOI: 10.1111/ajt.14726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 03/02/2018] [Indexed: 01/25/2023]
Abstract
Recent reports have shown an increase in the number of organ donors from drug intoxication. The impact of donor drug use on survival after cardiac transplant remains unclear. The aim of our study was to illustrate changes in donor death mechanisms and assess the impact on posttransplant survival. We queried United Network of Organ Sharing thoracic transplant and deceased donor databases to identify patients undergoing heart transplantation between 2005 and 2015. We evaluated annual trends in donor death mechanisms. Recipients were propensity matched (drug-intoxicated-non-drug-intoxicated = 1:2) and posttransplant survival was compared using Kaplan-Meier curves. In total, 19 384 donor hearts were used for transplant during the period (donor age 31.6 ± 11.8 years, 72% male). Use of drug-intoxicated donors increased from 2% (2005) to 13% (2015) and decreased from blunt injury (40%-30%) and intracranial hemorrhage (29%-25%). After propensity matching, posttransplant survival of drug-intoxicated donor hearts was 90%, 82%, and 76% at 1, 3, and 5 years, which was similar to non-drug-intoxicated. Heart transplants using drug-intoxicated donors have significantly increased; however, they have not adversely affected posttransplant survival. Hearts from drug-intoxicated donors should be carefully evaluated and considered for transplant.
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Affiliation(s)
- Mickey S Ising
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Michele Gallo
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - William M Whited
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jaimin R Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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