Cardiac Transplantation Italian Allocation System Analysis: Single Center Results

Abstract

<h3>Purpose</h3> Analyze the characteristic of donors and recipients in our center and the results of heart transplantations for the two different levels of priority according to Italian previous allocation system, urgent patients and elective ones. <h3>Methods</h3> From 2006 to August 2020, 306 heart transplantations were performed at our institution. Of them 54 (17.6%) in urgency. Reasons for urgency were: 24 patients on ECMO support, 8 on IABP and 13 on intravenous inotropes, 4 arrhythmic storms and 5 complicated LVAD. <h3>Results</h3> In the urgent population, recipients were predominantly male (68.5 % vs 77.4 % in the elective p=0.17) and significantly younger (46.4 vs 52.2 years, p=0.001). More patients were on ECMO support (42.6% vs 1.7% p=0.000), IABP (42.6 vs 6.7% p=0.000) and mechanically ventilated (46.2% vs 6% p=0.000) pre transplant. The donors of urgent patients were younger than donors of the elective ones (38.9 vs 42.4 years (p=0.06). Donor's gender (68% males) and cause of brain death (brain trauma 44,4%, and cerebral hemorrhage 35,2%) were comparable in the two groups. Mean ischemic time was longer in urgent cases (211 vs 191 minutes, p=0.01) as donations came from across the whole country. Severe Early Graft Failure (EGF) requiring ECMO occurred in 9.4% of patients in the urgent population vs 3.6% in the elective with no significant difference (p=0.076), as well as in hospital mortality that was 11.5% in urgent vs 8.3% (p=0.429). Recipients' risk factors for in-hospital mortality were age [OR 1.05 (1.01;1.09), p=0.028] and Glomerular Filtration Rate (GFR) < 40 ml/min [2.68 (1.04;6.92), p=0.047]. No donors' variable resulted to be a risk factor for in-hospital mortality. Episodes and grade of rejection did not diverge between groups, and so did follow up mortality (16.7% in urgent vs 22.4% in electives p=0.444) Mean follow up time for urgent population was shorter (53.6 vs 75.6 months (p=0.007). Overall 5 and 10 years' mortality was 79.7% and 62% vs 88.1% and 72.8% for urgent and elective patients respectively (p=0.721). <h3>Conclusion</h3> This retrospective analysis of our transplantation activity with the different priority regimen shows little differences in terms of mortality and complications. Despite the worse clinical characteristics of the urgent recipients and the longer ischemic time, results do not significantly differ from the elective population, underlying the importance of donation quality.