The Association of Donor Cause of Death with Outcomes Post-Heart Transplant

Abstract

ObjectiveApproximately 3000 orthotopic heart transplants (OHT) occur annually in the United States. Donor selection is a key decision point for patients undergoing transplantation. Donor factors such as age, BMI, left ventricular function, chest trauma, history of hemodynamic compromise, donor-recipient compatibility, and ischemic time have all been associated with post-transplant survival. Few studies have examined donor cause of death (DCOD) and its association with post-transplant outcomes. In this study we examine the association of DCOD with post-transplant primary graft dysfunction (PGD), rejection and survival.MethodsThis study was a retrospective analysis of 40,485 patients captured in the United Network for Organ Sharing (UNOS) registry. Included in this analysis were adult OHT recipients older than 18 years of age from 1989 to 2017. DCOD was categorized into blunt trauma (BT), cerebral vascular accidents (CVAs), and penetrating trauma (gunshot and stab wounds). Chi square analysis was used to compare baseline characteristics among the three groups. The Cox proportional hazard model was used to estimate the association of DCOD with PGD and acute rejection. The cumulative incidence competing risk method was used for survival analysis.ResultsDonors had a median age of 31 (interquartile range 22, 43), were predominately Caucasian (69%), and were predominately male 78%. 992 episodes of PGD were observed and occurred more frequently in the CVA group (41% vs BT 38% and penetrating trauma 19%, p 0.03). Univariate analysis showed a higher risk of acute graft failure (HR 1.24, CI 1.19-1.29, P <0.001) in the CVA group.ConclusionsDCOD by CVA is associated with an in increased risk of PGD and acute graft failure. Further multivariate analysis is needed. Approximately 3000 orthotopic heart transplants (OHT) occur annually in the United States. Donor selection is a key decision point for patients undergoing transplantation. Donor factors such as age, BMI, left ventricular function, chest trauma, history of hemodynamic compromise, donor-recipient compatibility, and ischemic time have all been associated with post-transplant survival. Few studies have examined donor cause of death (DCOD) and its association with post-transplant outcomes. In this study we examine the association of DCOD with post-transplant primary graft dysfunction (PGD), rejection and survival. This study was a retrospective analysis of 40,485 patients captured in the United Network for Organ Sharing (UNOS) registry. Included in this analysis were adult OHT recipients older than 18 years of age from 1989 to 2017. DCOD was categorized into blunt trauma (BT), cerebral vascular accidents (CVAs), and penetrating trauma (gunshot and stab wounds). Chi square analysis was used to compare baseline characteristics among the three groups. The Cox proportional hazard model was used to estimate the association of DCOD with PGD and acute rejection. The cumulative incidence competing risk method was used for survival analysis. Donors had a median age of 31 (interquartile range 22, 43), were predominately Caucasian (69%), and were predominately male 78%. 992 episodes of PGD were observed and occurred more frequently in the CVA group (41% vs BT 38% and penetrating trauma 19%, p 0.03). Univariate analysis showed a higher risk of acute graft failure (HR 1.24, CI 1.19-1.29, P <0.001) in the CVA group. DCOD by CVA is associated with an in increased risk of PGD and acute graft failure. Further multivariate analysis is needed.