Does Pre-Existing Donor Heart Coronary Artery Disease Impact Survival after Orthotopic Heart Transplantation?

Abstract

Purpose OPTN reports close to 3,900 heart transplant (HT) recipients awaiting heart transplantation in the US. With 2,000 transplants annually, nationwide HT volume cannot meet current demands. One factor limiting HT supply is that at many transplant centers, donor coronary artery disease (CAD) categorically excludes them as viable heart organ options. To evaluate the implications of widening the pool of acceptable donors, we investigated outcomes of patients who underwent HT from donor hearts with pre-existing CAD. Methods We sampled adult HT recipients enrolled through the UNOS database from 1987 to 2017. We categorized recipients into those receiving HT from donor hearts with (CAD) and without (No CAD ) groups. Re-transplants were excluded. Demographics were compared between CAD and No CAD groups via Wilcoxon- and Chi-Square-test . Kaplan-Meier and Log-rank tests were utilized to evaluate and compare survival. Results Among 8,602 HT recipients, 650 received hearts from donors with CAD (confirmed via coronary angiogram) while 7,952 patients received hearts from donors without CAD. In donors who did have an angiogram , mean age was 44.8. HT Recipient mean age was 54.7. There were no differences between CAD and No CAD groups with regards to most demographics. Survival was also similar between both groups, with median survival time being 139 and 122 months among No-CAD and CAD groups, respectively (p=0.42). 5-year survival was 74.0% vs 73.3% (NS), and 10-year survival 55.4% vs 51.7% (NS). Conclusion There was no difference in early or late survival between recipients with or without pre-existing donor CAD. Limitations include lack of detail about severity and extent of CAD. However, given our results, some recipients could benefit from HT from carefully selected donor hearts with CAD. Further studies are needed to confirm and expand on these findings.