Achievement of Donor Management Goals and Primary Graft Dysfunction after Heart Transplant

Abstract

Purpose Achievement of donor management goals (DMG), predefined critical care endpoints utilized to optimize donors prior to transplant, have been associated with increased organ utilization and decreased incidence of graft dysfunction following kidney transplant . Specifically, acceptable donor urine output and serum sodium have been associated with reduced incidence of renal graft dysfunction . This may reflect more optimal underlying donor health or improved critical care management. Association of DMG and outcomes following HT, including primary graft dysfunction (PGD), have not been previously described. Methods A cohort of HT recipients at our institution between 2012 to 2017 (n=645) was linked to their respective donors that were present in the UNOS DMG Registry (n=572). PGD was defined according to ISHLT criteria. DMG Registry variables with less than 15% missing values were subject to univariate logistic regression with PGD as the response variable (143 variables). Statistically significant variables were then subject to multivariable logistic regression. Results Moderate-severe PGD occurred in 46 (8%) HT recipients. Achievement of an increasing number of DMG was not associated with a decreased risk of PGD (p = 0.28). However, meeting the urine output DMG at authorization was associated with a decreased risk of PGD (OR 0.47, p=0.023). This remained significant after controlling for other donor and recipient factors (TABLE). Conclusion Achievement of the urine output DMG was associated with a decreased risk of PGD after HT. A proposed mechanism may be improved renal perfusion reflecting optimal cardiac output. Although achieving DMG appears to represent more healthy donors, further research is needed to understand physiologic mechanisms of decreased donor urine output and PGD.