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. 2013 Mar;6(2):300-9.
doi: 10.1161/CIRCHEARTFAILURE.112.000165. Epub 2013 Feb 7.

Donor predictors of allograft use and recipient outcomes after heart transplantation

Kiran K Khush  1 , Rebecca Menza, John Nguyen, Jonathan G Zaroff, Benjamin A Goldstein
Affiliations

Donor predictors of allograft use and recipient outcomes after heart transplantation

Kiran K Khush et al. Circ Heart Fail. 2013 Mar.

Abstract

Background: Despite a national organ-donor shortage and a growing population of patients with end-stage heart disease, the acceptance rate of donor hearts for transplantation is low. We sought to identify donor predictors of allograft nonuse, and to determine whether these predictors are in fact associated with adverse recipient post-transplant outcomes.

Methods and results: We studied a cohort of 1872 potential organ donors managed by the California Transplant Donor Network from 2001 to 2008. Forty-five percent of available allografts were accepted for heart transplantation. Donor predictors of allograft nonuse included age >50 years, female sex, death attributable to cerebrovascular accident, hypertension, diabetes mellitus, a positive troponin assay, left-ventricular dysfunction and regional wall motion abnormalities, and left-ventricular hypertrophy. For hearts that were transplanted, only donor cause of death was associated with prolonged recipient hospitalization post-transplant, and only donor diabetes mellitus was predictive of increased recipient mortality.

Conclusions: Whereas there are many donor predictors of allograft discard in the current era, these characteristics seem to have little effect on recipient outcomes when the hearts are transplanted. Our results suggest that more liberal use of cardiac allografts with relative contraindications may be warranted.

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Conflict of interest statement

The authors have no further conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Odds ratios for cardiac allograft acceptance for transplantation, by donor risk factors
Figure 2
Figure 2
Effect of allograft predicted probability of utilization (< or >50%) on (a) time to hospital discharge after heart transplantation, and (b) 1 year graft survival.
Figure 3
Figure 3
Associations between number of donor risk factors and heart transplant recipient outcomes (discharge within 21 days post-transplant, 30 day graft survival, and 1 year graft survival)
Figure 4
Figure 4
Receiver operating characteristic curves, based on Random Forest models, for donor prediction of (1) cardiac allograft utilization for transplantation, (2) discharge within 21 days post-transplant, (3) 30 day graft survival, (4) 1 year graft survival.
See this image and copyright information in PMC

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