Influence of Donor Transfusion on Heart Transplantation Outcomes: A United Network for Organ Sharing Registry Analysis

Abstract

Introduction: There is a lack of evidence regarding the impact of donor blood transfusion on heart transplant (HT) outcomes. We sought to elucidate the influence of donor transfusion on HT outcomes using the national database.

Methods: From January 2004 to March 2023, donor transfusion information was available for 40 538 recipients for HT in the United Network for Organ Sharing (UNOS) database. We used the UNOS 4-level designation of transfusion (no blood [N = 18 575], 1-5 units [N = 14 098], 6-10 units [N = 4766], and massive transfusion of > 10 units [N = 3099]).

Results: Among this cohort, 53.2% of donors (N = 20 220) received a blood transfusion during the same admission. Donors who required blood transfusion commonly had head trauma as a cause of death (no-blood, 22% vs. 1-5 units, 61%, 6-10 units, 88%, massive, 89%, p < 0.001). An increased amount of donor blood transfusion did not affect rates of acute rejection (no-blood, 18% vs. 1-5 units, 19%, 6-10 units, 17%, massive, 19%, p = 0.13). The number of units transfused also did not affect 1-year survival rates. The Cox hazard model showed no effect of massive transfusion on mortality following transplant (no-blood, reference vs. 1-5 units; HR, 1.02 [p = 0.35], 6-10 units; HR, 1.10 [p = 0.01], massive transfusion; HR 1.04 [p = 0.3]).

Conclusions: Massive transfusion in donors was not associated with increased recipient mortality. Additionally, the amount of donor blood transfusion did not affect rejection rates following HT. The present study suggests that a history of donor blood transfusion, as well as the amount of transfusion, should not preclude donor heart utilization.

Keywords: blood transfusion; donor; heart transplant.