Donor hypernatremia and smoking addiction contribute to primary graft failure in heart transplantation.

Abstract

Primary graft failure (PGF) is an important contributor to early mortality, accounting for 41% of deaths within the first 30days after heart transplantation (HT). Donor hypernatremia has been associated with PGF development. However, controversial data exist regarding the impact of sodium deregulation in patient survival after HT. This study aimed to assess the influence of donor hypernatremia on PGF development and to determine the serum sodium level threshold to assist in decision-making for organ procurement. The medical record from 200 HT patients and organ donors were retrospectively assessed and categorized by PGF occurrence. Donor sodium levels were compared and cut-off points obtained by receiver operating characteristic (ROC) curve. A multiple logistic regression model was applied to assess the effects of factors and covariates that influence PGF development. Sodium levels of donors were significantly higher in recipients who developed PGF than those who did not develop PGF (162 vs. 153mmol/L, P=.001). The sodium cut-off value determined by the ROC curve was 159mmol/L. The group who received organs from donors with a serum sodium concentration ≥159mmol/L had a higher incidence of PGF (63.3% vs 32.4%, P<.001). Furthermore, donor sodium levels ≥159mmol/L increased the likelihood of recipients developing PGF by 3.4 times. It is also observed that the incidence of donor smoking addiction was significantly higher in the PGF group (28.6% vs. 11.5%, P=.004) and donor smoking addiction increased the risk of developing PGF by 2.8 times. Smoking addiction and the application of suboptimal organs from donors with hypernatremia contribute to primary graft failure in heart transplantation.