The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

Soo Yong Lee; Seok Hyun Kim; Min Ho Ju; Mi Hee Lim; Chee-hoon Lee; Hyung Gon Je; Ji Hoon Lim; Ga Yun Kim; Ji Soo Oh; Jin Hee Choi; Min Ku Chon; Sang Hyun Lee; Ki Won Hwang; Jeong Su Kim; Yong Hyun Park; June Hong Kim; Kook Jin Chun

doi:https://doi.org/10.4070/kcj.2022.0197

The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

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Type: Academic journal

Author: Soo Yong Lee (Pusan National University Yangsan Hospital) Seok Hyun Kim (Pusan National University Yangsan Hospital) Min Ho Ju (Pusan National University Yangsan Hospital) Mi Hee Lim (Pusan National University Yangsan Hospital) Chee-hoon Lee (Pusan National University Yangsan Hospital) Hyung Gon Je (Pusan National University Yangsan Hospital)

Journal: The Korean Society of Cardiology Korean Circulation Journal Korean Circulation Journal Vol.53 No.4 KCI Accredited Journals

Published: 2023.4

Pages: 254 - 267 (14page)

DOI: https://doi.org/10.4070/kcj.2022.0197

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The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

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Background and Objectives: Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx. Methods: Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed. MD was defined as follows; a donor age >55 years, left ventricular ejection fraction <50%, cold ischemic time >240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10). Results: A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01). Conclusions: The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and long-term outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.

#Heart transplantation #Transplant donors #Selection #Survival

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