Donor cause of death does not affect medium-term survival after heart transplantation - a UK national study

Abstract

Donor cause of death (DCD) may be a risk factor for early mortality following heart transplantation (HTX), but its effect on longer-term survival is uncertain. We investigated the influence of DCD on survival to 3 years, using a national prospective database in 1233 adult recipients of cadaveric HTx between July 1995 and June 2002. DCD was categorised a priori to: vascular and tumour (V, n = 725), trauma (T, n = 402), hypoxic (H, n = 80) and infective causes (I, n = 26). Risk factors for early (30-day), late (30-days to 3-year) and overall mortality were identified using Cox regression. V donors were older (median 40 years vs. <26 years); V and H groups had proportionally fewer males (p < 0.001); and V recipients had a higher incidence of previous heart surgery (p = 0.02). There were 286 total deaths. Unadjusted 3-year survival varied significantly with DCD (p = 0.01). Cox analysis identified donor age, organ ischaemia time, recipient creatinine clearance, recipient diagnosis, peripheral vascular disease, ventilation, diabetes, and donor-recipient size mismatch as risk factors for early, late and/or overall mortality (p < 0.10). After adjusting for these factors, DCD was no longer a significant predictor of recipient death (early death, p = 0.5, late death, p = 0.7, overall mortality, p = 0.14). We have confirmed the previous observation of an apparent association between cause of donor death and post transplant survival but this was not maintained after adjustment for confounding variables. DCD is not an independent risk factor for mortality up to 3 years after HTx.