Donor Alkalemia is Associated with Severe Primary Graft Dysfunction

Abstract

<h3>Purpose</h3> Primary graft dysfunction (PGD) following heart transplant (HT) is a significant cause of early mortality. Donor management goals (DMG) are 9 predefined endpoints used to optimize donors before procurement. We evaluated the relationship between meeting DMGs and the development of severe PGD after HT. <h3>Methods</h3> We identified 648 HT recipients at our center between 1/1/2012 and 12/31/2019 with donor data and complete covariates in the UNOS DMG Registry. DMGs were collected at consent, 12-18 hours into management, and at procurement. PGD was defined according to modified ISHLT criteria. The ABCE (ACE inhibitor/Beta-blocker/Cardiac surgery/ischemic timE) prediction score for severe PGD was also used. DMG registry variables were subject to single variable and multivariable multinomial modeling with development of severe PGD as the response variable. The DMG goal range for pH is 7.3-7.5. <h3>Results</h3> 110 (17%) of the cohort had mild/moderate PGD and 43 (6%) had severe PGD. In single variable modeling, the only DMG associated with severe PGD was donor pH within goal range at procurement. There were 576 donors (89%) at goal pH, 66 (10%) alkalotic, and 6 (1%) acidotic/missing. Donor alkalemia at procurement was associated with an increased risk for severe PGD (OR 2.45, 95% CI 1.02-5.91, p=0.046). When added to the ABCE prediction score for severe PGD, donor alkalemia at procurement was not independently associated with severe PGD (Table 1). <h3>Conclusion</h3> In this cohort, donor alkalemia at procurement was associated with an increased risk of severe PGD, but not beyond recipient factors associated with severe PGD (ABCE score). Donor alkalemia is a novel risk factor for PGD that may be related to donor ventilation. Given the need for novel markers that predict PGD, additional studies in larger, multi-institutional cohorts are warranted.