Impact of donor ventricular function on heart transplantation outcomes.

Abstract

Some heart transplant (HTx) centers have expanded their donor eligibility criteria in response to the organ shortage; one area of active interest involves utilizing hearts with ventricular dysfunction. Our study seeks to identify if a relationship exists between donor left ventricular ejection fraction (LVEF) and ischemic time or donor age on HTx outcomes. We performed a retrospective analysis on adult patients who had a HTx between 1996 and 2021 (n=46,936). Donor LVEF (dLVEF) values were categorized into three groups:<50%, 50%-70%, and >70%. Ischemic time and donor age were stratified into four groups: ≤2.0, 2.1-3.0, 3.1-4.0,>4.0h, and ≤30, 31-40, 41-50, >50 years, respectively. The outcome of interest was long-term survival. Multivariable survival analysis found a slight increase in overall mortality risk for patients with donor ejection fractions <50% (HR=1.16, p=.013). However, subsequent subgroup investigation discovered that this elevated hazard was only applicable when ischemic time was prolonged to>3.0h (3.1-4.0h: HR=1.23, p=.024;>4.0h: HR=1.52, p<.001). There was no significant difference in survival between dLVEF groups when ischemic time was limited to ≤3.0h or when stratified by donor age. HTx patients with a low donor ejection fraction have comparable survival to recipients with a normal dLVEF when ischemic time is limited to ≤3.0h. Reduced dLVEF does not appear to be sensitive to advanced donor age. The clinical implications of our study may encourage the recruitment of more donor hearts for transplantation.