Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database

R A Sorabella; L Guglielmetti; A Kantor; E Castillero; H Takayama; P C Schulze; D Mancini; Y Naka; I George

doi:10.1016/j.transproceed.2015.10.021

Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database

Transplant Proc. 2015 Dec;47(10):2944-51. doi: 10.1016/j.transproceed.2015.10.021.

Authors

R A Sorabella¹, L Guglielmetti¹, A Kantor¹, E Castillero¹, H Takayama¹, P C Schulze², D Mancini², Y Naka¹, I George³

Affiliations

¹ Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
² Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
³ Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA. Electronic address: ig2006@cumc.columbia.edu.

Abstract

Introduction: To address the shortage of donor hearts for transplantation, there is significant interest in liberalizing donor acceptance criteria. Therefore, the aim of this study was to evaluate cardiac donor characteristics from the United Network for Organ Sharing (UNOS) database to determine their impact on posttransplantation recipient outcomes.

Methods: Adult (≥18 years) patients undergoing heart transplantation from July 1, 2004, to December 31, 2012, in the UNOS Standard Transplant Analysis and Research (STAR) database were reviewed. Patients were stratified by 1-year posttransplantation status; survivors (group S, n = 13,643) and patients who died or underwent cardiac retransplantation at 1-year follow-up (group NS/R = 1785). Thirty-three specific donor variables were collected for each recipient, and independent donor predictors of recipient death or retransplantation at 1 year were determined using multivariable logistic regression analysis.

Results: Overall 1-year survival for the entire cohort was 88.4%. Mean donor age was 31.5 ± 11.9 years, and 72% were male. On multivariable logistic regression analysis, donor age >40 years (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.27 to 1.64), graft ischemic time >3 hours (OR 1.32, 1.16 to 1.51), and the use of cardioplegia (OR 1.17, 1.01 to 1.35) or Celsior (OR 1.21, 1.06 to 1.38) preservative solution were significant predictors of recipient death or retransplantation at 1 year posttransplantation. Male donor sex (OR 0.83, 0.74 to 0.93) and the use of antihypertensive agents (OR 0.88, 0.77 to 1.00) or insulin (OR 0.84, 0.76 to 0.94) were protective from adverse outcomes at 1 year.

Conclusions: These data suggest that donors who are older, female, or have a long projected ischemic time pose greater risk to heart transplant recipients in the short term. Additionally, certain components of donor management protocols, including antihypertensive and insulin administration, may be protective to recipients.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Age Factors
Antihypertensive Agents / therapeutic use
Cold Ischemia / mortality
Databases, Factual
Female
Graft Survival*
Heart Transplantation / mortality*
Humans
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Logistic Models
Male
Middle Aged
Odds Ratio
Reoperation / statistics & numerical data
Risk Factors
Sex Factors
Survivors / statistics & numerical data
Time Factors
Tissue Donors / statistics & numerical data*

Substances

Antihypertensive Agents
Hypoglycemic Agents
Insulin

Abstract

Publication types

MeSH terms

Substances

Grants and funding