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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Donor hyperoxia is a novel risk factor for severe cardiac primary graft dysfunction

Published:January 05, 2023DOI:https://doi.org/10.1016/j.healun.2022.12.022

      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)
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