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. 2023 Sep 5;148(10):822-833.
doi: 10.1161/CIRCULATIONAHA.122.063400. Epub 2023 Jul 19.

Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study

Kiran K Khush  1 , Darren Malinoski  2 , Helen Luikart  1 , Brian Wayda  1 , Tahnee Groat  2 , John Nguyen  3 , John Belcher  4 , Javier Nieto  5 , Nikole Neidlinger  6 , Ahmad Salehi  7 , P J Geraghty  8 , Bruce Nicely  9 , Martin Jendrisak  10 , Thomas Pearson  11 , R Patrick Wood  5 , Shiqi Zhang  12 , Yingjie Weng  12 , Jonathan Zaroff  13
Affiliations

Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study

Kiran K Khush et al. Circulation. .

Abstract

Background: Left ventricular dysfunction in potential donors meeting brain death criteria often results in nonuse of donor hearts for transplantation, yet little is known about its incidence or pathophysiology. Resolving these unknowns was a primary aim of the DHS (Donor Heart Study), a multisite prospective cohort study.

Methods: The DHS enrolled potential donors by neurologic determination of death (n=4333) at 8 organ procurement organizations across the United States between February 2015 and May 2020. Data included medications administered, serial diagnostic tests, and transthoracic echocardiograms (TTEs) performed: (1) within 48 hours after brain death was formally diagnosed; and (2) 24±6 hours later if left ventricular (LV) dysfunction was initially present. LV dysfunction was defined as an LV ejection fraction <50% and was considered reversible if LV ejection fraction was >50% on the second TTE. TTEs were also examined for presence of LV regional wall motion abnormalities and their reversibility. We assessed associations between LV dysfunction, donor heart acceptance for transplantation, and recipient 1-year survival.

Results: An initial TTE was interpreted for 3794 of the 4333 potential donors by neurologic determination of death. A total of 493 (13%) of these TTEs showed LV dysfunction. Among those donors with an initial TTE, LV dysfunction was associated with younger age, underweight, and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) and troponin levels. A second TTE was performed within 24±6 hours for a subset of donors (n=224) with initial LV dysfunction; within this subset, 130 (58%) demonstrated reversibility. Sixty percent of donor hearts with normal LV function were accepted for transplant compared with 56% of hearts with reversible LV dysfunction and 24% of hearts with nonreversible LV dysfunction. Donor LV dysfunction, whether reversible or not, was not associated with recipient 1-year survival.

Conclusions: LV dysfunction associated with brain death occurs in many potential heart donors and is sometimes reversible. These findings can inform decisions made during donor evaluation and help guide donor heart acceptance for transplantation.

Keywords: brain death; heart transplantation; left; tissue donors; ventricular dysfunction.

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Conflict of interest statement

Disclosures The data reported here have been supplied by the Donor Management Goals Advisory Group. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the Donor Management Goals Advisory Group. Similarly, the data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the Organ Procurement and Transplantation Network or the US government.

Figures

Figure 1:
Figure 1:
Overview of Donor Heart Study protocol
Figure 2:
Figure 2:
Donor Heart Study CONSORT diagram, demonstrating the number of eligible and enrolled donors, and availability of echocardiogram data by core interpretation. *Those used for any solid organ transplant, but not enrolled in DHS (n = 6,627) are compared with DHS enrolled donors (n = 4,333) in Supplemental Table 1. CONSORT: Consolidated Standards of Reporting Trials, LVEF: left ventricular ejection fraction
Figure 3:
Figure 3:
Histograms of LVEF distribution on the first donor echocardiogram, by local and core interpretation, and their correlation
Figure 4:
Figure 4:
One year post-transplant survival in donors with normal LV function, donors with reversible LV dysfunction, and donors with non-reversible LV dysfunction
See this image and copyright information in PMC

References

    1. Dharmavaram N, Hess T, Jaeger H, Smith J, Hermsen J, Murray D and Dhingra R. National Trends in Heart Donor Usage Rates: Are We Efficiently Transplanting More Hearts? J Am Heart Assoc. 2021;10:e019655. - PMC - PubMed
    1. Khush KK, Zaroff JG, Nguyen J, Menza R and Goldstein BA. National decline in donor heart utilization with regional variability: 1995–2010. Am J Transplant. 2015;15:642–9. - PMC - PubMed
    1. Tryon D, Hasaniya NW, Jabo B, Razzouk AJ, Bailey LL and Rabkin DG. Effect of left ventricular dysfunction on utilization of donor hearts. J Heart Lung Transplant. 2018;37:349–357. - PubMed
    1. Zaroff JG, Babcock WD and Shiboski SC. The impact of left ventricular dysfunction on cardiac donor transplant rates. J Heart Lung Transplant. 2003;22:334–7. - PubMed
    1. Audibert G, Charpentier C, Seguin-Devaux C, Charretier PA, Gregoire H, Devaux Y, Perrier JF, Longrois D and Mertes PM. Improvement of donor myocardial function after treatment of autonomic storm during brain death. Transplantation. 2006;82:1031–6. - PubMed

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