Background
Primary graft dysfunction (PGD) is a major cause of early mortality following heart
transplant (HT). Donor risk factors for the development of PGD are incompletely characterized.
Donor management goals (DMG) are predefined critical care endpoints used to optimize
donors. We evaluated the relationship between DMGs as well as non-DMG parameters,
and the development of PGD after HT.
Methods
A cohort of HT recipients from 2 transplant centers between 1/1/12 and 12/31/19 was
linked to their respective donors in the United Network for Organ Sharing (UNOS) DMG
Registry (n = 1,079). PGD was defined according to modified ISHLT criteria. Variables were subject
to univariate and multivariable multinomial modeling with development of mild/moderate
or severe PGD as the outcome variable. A second multicenter cohort of 4,010 donors
from the DMG Registry was used for validation.
Results
Mild/moderate and severe PGD occurred in 15% and 6% of the cohort. Multivariable modeling
revealed 6 variables independently associated with mild/moderate and 6 associated
with severe PGD, respectively. Recipient use of amiodarone plus beta-blocker, recipient
mechanical circulatory support, donor age, donor fraction of inspired oxygen (FiO2), and donor creatinine increased risk whereas predicted heart mass ratio decreased
risk of severe PGD. We found that donor age and FiO2 ≥ 40% were associated with an increased risk of death within 90 days post-transplant
in a multicenter cohort.
Conclusions
Donor hyperoxia at heart recovery is a novel risk factor for severe primary graft
dysfunction and early recipient death. These results suggest that excessive oxygen
supplementation should be minimized during donor management.
KEYWORDS
Abbreviations:
ACEI (angiotensin converting enzyme inhibitor), AMIO (amiodarone), ARB (angiotensin receptor antagonist), ARNI (angiotensin receptor - neprilysin inhibitor), AUROC (area under the receiver operating characteristic curve), BB (beta blocker), DMG (donor management goal), ECMO (extracorporeal membrane oxygenation), FiO2 (fraction of inspired oxygen), HT (heart transplant), ISHLT (International Society for Heart and Lung Transplantation), MCS (mechanical circulatory support), MRA (mineralocorticoid receptor antagonist), OPO (organ procurement organization), PGD (primary graft dysfunction), PO2 (atrial partial pressure of oxygen), ROS (reactive oxygen species), RVAD (right ventricular assist device), UNOS (United Network for Organ Sharing)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 05, 2023
Publication stage
In Press Journal Pre-ProofIdentification
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© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
