Background
We evaluated post-heart transplant (HTx) outcomes after use of higher-risk donor hearts
for candidates supported with pre-HTx mechanical circulatory support (MCS).
Methods
In this retrospective analysis of the national United Network for Organ Sharing registry,
a total of 9,915 adult candidates on MCS underwent HTx from January 1, 2010 to March
31, 2019. Multi-organ, re-transplant, and congenital heart disease patients were excluded.
Higher-risk donor organs met at least one of the following criteria: left ventricular
ejection fraction <50%, donor to recipient predicted heart mass ratio <0.86, donor
age >55 years, or ischemic time >4 hours. Primary outcome was 1 year post-transplant
survival.
Results
Among HTx recipients, 3688 (37.2%) received higher-risk donor hearts. Candidates supported
with pre-HTx extracorporeal membrane oxygenation or biventricular assist device (n = 374, 3.8%) who received higher-risk donor hearts had comparable 1 year survival
(HR: 1.14, 95% CI: [0.67-1.93], p = 0.64) to recipients of standard-risk donor hearts, when adjusted for recipient
age and sex. In candidates supported with intra-aortic balloon pump (n = 1391, 14.6%), transplantation of higher-risk donor hearts did not adversely affect
1 year survival (HR: 0.80, 95% CI: [0.52-1.22], p = 0.30). Patients on durable left ventricular assist devices (LVAD) who received
higher-risk donor hearts had comparable 1 year survival to continued LVAD support
on the waitlist, but mortality was increased compared to those who received standard-risk
donor hearts (HR: 1.37, 95% CI: [1.11-1.70], p = 0.004).
Conclusions
Patients requiring pre-HTx temporary MCS who received higher-risk donor hearts had
comparable 1 year post-transplant survival to those who received standard-risk donor
hearts. Stable patients on durable LVADs may benefit from waiting for standard-risk
donor hearts.
Keywords
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Article info
Publication history
Published online: October 21, 2021
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© 2021 International Society for Heart and Lung Transplantation. All rights reserved.
