Abstract
<h3>Purpose</h3> Multiple donor and recipient characteristics contribute to the pathogenesis of primary graft dysfunction (PGD) after heart transplantation (HT). The purpose of this study was to determine the association between spontaneous donor hypothermia and PGD. <h3>Methods</h3> Consecutive adult HT recipients (n=1106) from 3/2012 to 12/2019 at two high-volume centers were included. Severe PGD was defined using the ISHLT consensus statement. Donor physiologic parameters were collected from the United Network for Organ Sharing Donor Management Goals registry. Univariable and multivariable logistic modeling were performed. <h3>Results</h3> Donors were predominantly male (66.6%), with a mean donor age of 34.9±13.0 years. Severe PGD occurred in 66 (6.0%) patients. Patients with severe PGD were more likely to receive organs from older donors (38.0±13.0 vs. 34.7±12.7 years, p=0.04) and lower donor to recipient heart mass ratio (1.00±0.15 vs. 1.05±0.20, p=0.048). Single variable modeling showed predicted heart mass ratio, donor age, and spontaneous donor hypothermia defined as less than 36 degrees Celsius at time of procurement to be significant predictors of severe PGD. Multivariable modeling showed that spontaneous donor hypothermia (OR 2.21, 95% CI: [1.21-4.03], p=0.01) was significantly associated with severe PGD after adjusting for donor age and predicted heart mass ratio. There was no increased incidence of severe PGD with spontaneous donor hypothermia either at time of referral (OR: 1.35, 95% CI: [0.78-2.35], p=0.28) or 12 to 18 hours later (OR: 1.16, 95% CI: [0.51-2.66], p=0.71). Spontaneous donor hyperthermia defined as greater than 37.5 degrees Celsius at time of procurement was not associated with severe PGD (OR: 1.69, 95% CI: [0.64-4.45], p=0.29). <h3>Conclusion</h3> Spontaneous donor hypothermia at time of organ procurement is associated with an increased risk of severe PGD.
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