Can Donor Step Up Pressure Predict Primary Graft Dysfunction in Recipients Post Heart Transplantation?

Abstract

Purpose Donor right ventricular (RV) function is difficult to assess prior to organ retrieval. The RV is also subjected to a multitude of insults post brainstem death which may be exacerbated by prolonged ischaemia prior to implantation. To date, there is no consensus on a method to accurately evaluate RV function in a transplant cohort. We propose using the ‘step-up’(Mean Pulmonary Arterial Pressure - Right Atrial Pressure) pressure as a tool to evaluate donor RV function. Our aim was to study this association and the incidence of Primary Graft Dysfunction Methods A retrospective review all patients who underwent heart transplantation between June 2010-October 2018 at our centre. We identified 92 donors who had invasive haemodynamic monitoring prior to retrieval at the donor hospitals. The primary endpoint for the study was ISHLT-defined PGD. We stratified the cohort into 2 categories of step-up pressure 10mmHg. Multivariable logistic regression analysis was performed to calculate the odds ratio of developing PGD in Group 2 compared to Group 1. Potential confounders adjusted for were donor age, donor inotrope score, warm ischaemic time, recipient pulmonary vascular resistance, donor-recipient gender mismatch and preoperative mechanical circulatory support in the recipient. Results The mean age of donors was 39.4±12.2years. There were 41(44.6%) female donors. The median age of recipients was 46.6±11.7 years. The incidence of PGD was 36(39%). Conclusion The step-up pressure is not a predictor of PGD in our cohort. Donor age and warm ischaemic time were both associated with PGD