Abstract
BackgroundHeart transplantation is limited by severe donor organ shortage. Regardless of the changes made in the acceptance of marginal donors, any such mechanism cannot be considered successful unless recipient graft survival rates remain acceptable. A stress echo-driven selection of donors has proven successful in older donors with normal left ventricular resting function and in standard donors with reversible resting left ventricular dysfunction acutely improving during stress, or slowly improving (over hours) during intensive hormonal treatment. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected with new echocardiographic techniques over standard criteria.Methods and resultsWe enrolled 43 recipients of marginal donor hearts: age > 55 years, or < 55 years but with concomitant risk factors, n = 32; acutely improving during stress, n = 3; or slowly improving during hormonal treatment, n = 8. At follow-up (median, 30 months; interquartile range, 21–52 months), 37 of the recipients were still alive. One-year survival was 93%.ConclusionThe strict use of new stress-echocardiographic techniques over standard criteria of marginal donor management, together with comprehensive monitoring of the donor, has the potential to substantially increase the number of donor hearts without adverse effects on recipient medium-term outcome.
Highlights
Heart transplantation is an established procedure in end-stage heart failure patients, albeit limited by severe and incremental donor organ shortage
Patients were enrolled from a waiting list: 5 recipients were United Network for Organ Sharing (UNOS) status 1A, 7 recipients were status 1B, and 31 were status 2 [20]
Six recipients died at follow-up: two recipients had primary graft failure after Hormonal treatment (HT), one recipient with severe pre-TX pulmonary hypertension and one recipient with previously implanted Ventricular assist device (VAD) as bridge to TX; two died from general sepsis; one died at 32 months from allograft vasculopathy [21] in recurrent multiple myeloma; one died at 16 months from newly diagnosed liver cancer
Summary
Heart transplantation is an established procedure in end-stage heart failure patients, albeit limited by severe and incremental donor organ shortage. A stress echo-driven selection of donors has. Heart transplantation is limited by severe donor organ shortage. Regardless of the changes made in the acceptance of marginal donors, any such mechanism cannot be considered successful unless recipient graft survival rates remain acceptable. A stress echo-driven selection of donors has proven successful in older donors with normal left ventricular resting function and in standard donors with reversible resting left ventricular dysfunction acutely improving during stress, or slowly improving (over hours) during intensive hormonal treatment. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected with new echocardiographic techniques over standard criteria
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