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. 2022 May 9;11(9):2665.
doi: 10.3390/jcm11092665.

Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit

Olimpia Bifulco  1 , Tomaso Bottio  1 , Raphael Caraffa  1 , Massimiliano Carrozzini  2 , Alvise Guariento  1 , Jonida Bejko  3 , Marny Fedrigo  1 , Chiara Castellani  1 , Giuseppe Toscano  1 , Giulia Lorenzoni  1   4 , Vincenzo Tarzia  1 , Dario Gregori  1   4 , Massimo Cardillo  5 , Francesca Puoti  5 , Giuseppe Feltrin  6 , Annalisa Angelini  1 , Gino Gerosa  1
Affiliations

Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit

Olimpia Bifulco et al. J Clin Med. .

Abstract

Background: In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD).

Methods: All patients who underwent HTx between January 2012 and December 2020 were enrolled at a single institution. The primary endpoints were early and long-term survival of MD recipients. Risk factors for primary graft failure (PGF) and mortality in MD recipients were also analyzed. The secondary endpoint was the comparison of survival of MD versus SD recipients.

Results: In total, 238 patients underwent HTx, 64 (26.9%) of whom received an organ from an MD. Hospital mortality in the MD recipient cohort was 23%, with an estimated 1 and 5-year survival of 70% (59.2-82.7) and 68.1% (57.1-81), respectively. A multivariate analysis in MD recipients showed that decreased renal function and increased inotropic support of recipients were associated with higher mortality (p = 0.04 and p = 0.03). Cold ischemic time (p = 0.03) and increased donor inotropic support (p = 0.04) were independent risk factors for PGF. Overall survival was higher in SD than MD (85% vs. 68% at 5 years, log-rank = 0.008). However, risk-adjusted mortality (p = 0.2) and 5-year conditional survival (log-rank = 0.6) were comparable.

Conclusions: Selected MDs are a valuable resource for expanding the cardiac donor pool, showing promising results. The use of MDs after prolonged ischemic times, increased inotropic support of the MD or the recipient and decreased renal function are associated with worse outcomes.

Keywords: heart marginal donors; in-hospital mortality; mid-term survival; standard donors and marginal donors’ comparison.

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Conflict of interest statement

All authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Overall survival in HTx population. Survival at 1 year was 81.2% (76.3–86.5%), at 8 years 79.6% (74.5–85.1%).
Figure 2
Figure 2
Graphical representation of linear and significant association between cold ischemic time in MDs and primary graft failure onset. (Logistic regression model).
Figure 3
Figure 3
(A) Overall survival in SDs compared to MDs; (B) 5-year conditional survival of MDs compared to SDs.
See this image and copyright information in PMC

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