Impact of Heart Donor “Inotrope” Support on 30-Day Graft Outcomes in Heart Transplantation

Abstract

Purpose Potential heart donor blood pressure is often supported with agents that are primarily vasoconstrictors such as vasopressin, dopamine, and phenylephrine as single infusions or in combination. Less commonly, agents with important inotropic effects such as dobutamine, levophed, and epinephrine are also used. These could potentially improve the inotropic state of a damaged heart and lead transplant centers to make poor decisions. We hypothesized that the use of inotropic support of heart donors would increase 30 day mortality in cardiac recipients. Methods and Materials A multivariate logistic regression analysis of UNOS database from 1987 to 2011 was made, comparing the inotrope and pressor groups available from the UNOS database. The drug categories available for comparison from that database were: “three or more inotropes or pressors”, a “single inotrope or pressor”, “dobutamine only”, and “dopamine only”. These groups were not mutually exclusive except for the 2 “only” categories. The primary outcome was defined as graft failure or recipient death within 30 days after transplantation. Results A total of 37,605 transplants that had cardiac donors treated within 24 hours of procurement with inotrope(s) and/ or pressor(s) were analyzed. There was no significant difference in the 30-day graft failure rate or mortality rate for patients among the four categories 3 or more inotropes, versus patients with less than 3 or no inotropes(0.89% vs 1.06% p=0.377). On adjusted analysis, PRA > 17%, ischemic time, high recipient BMI, donor age, recipient ethnicity (African American and Asian), an older recipient age (age >40) and the presence of a ventricular assist device or total artificial heart were associated with 30-day graft failure. Conclusions Among the 4 groups, there was no difference in 30 day graft survival or recipient mortality. Thus, the use of dobutamine and other inotropes is no more detrimental than the standard dopamine or alpha agent therapy.