Abstract 17011: Impact of Donor Cardiopulmonary Resuscitation Duration on Survival After Heart Transplantation

Abstract

Introduction: Prolonged cardiopulmonary resuscitation (CPR) duration remains a source of apprehension with regards to the acceptance of donor hearts for orthotopic heart transplantation (OHT). Unfortunately, many of these organs are declined due to concern for adverse outcomes after OHT, further straining an already limited donor pool. Nevertheless, donor hearts with a history of prolonged CPR may represent an opportunity to expand the donor pool for patients with end-stage heart failure on the waiting list for OHT. Therefore, we sought to examine the duration of donor CPR and its impact on recipient survival after OHT. Methods: The United Network of Organ Sharing (UNOS) database was retrospectively quarried to identify all adult patients who underwent first-time OHT between 2000 and 2019 from a donor who had experienced cardiac arrest with a quantified downtime duration. The population was divided into five groups with a granular focus on longer downtimes: donors with CPR < 30 minutes, 30-39 minutes, 40-49 minutes, 50-59 minutes, and ≥ 60 minutes. Primary outcome of interest was post-transplant survival. Kaplan-Meier analysis was used to compare recipient survival between groups after OHT. Results: In total, 7,470 patients were identified during the study period. Overall survival by Kaplan-Meier analysis was not statistically different among the five groups (p=0.69) (Figure 1). In a Cox proportional-hazards model, duration of CPR was found to have no influence on survival (HR 1.00, p=0.56). Significant predictors of mortality included donor age (HR 1.01, p=0.013), donor smoking history (HR 1.11, p<0.005), and recipient diabetes (HR 1.27, p<0.0001). Conclusions: These findings suggest that, for hearts determined appropriate for transplant, duration of CPR performed on the donor heart does not significantly impact survival after OHT. Therefore, donor hearts with a prolonged downtime should be fully evaluated for OHT to maximize the donor pool.