The Effect of Donor Heart Risk Factors on Cardiac Transplantation

Abstract

To examine the effect of common donor risk factors on post heart transplant outcomes. Utilizing the UNOS/SRTR database we identified all adult primary heart transplants after July 1, 2006. Six donor RFs were identified: age > 50, documented coronary disease, smoking history, recent cocaine use, diabetes and hypertension. Donors were categorized by: no RFs, 1 RF, 2 RFs, or 3+ RFs. The groups were compared using an analysis of variance or chi-square test for continuous and categorical variables, respectively. A Cox proportional hazards model and Kaplan Meier analysis were performed. 26,793 heart transplants were identified. The most common donor RF was recent cocaine use. Use of donors with more RFs was associated with older recipients (p<0.01). More RFs were associated with increased travel distance and 30/90 day mortality (Table). Unadjusted Kaplan Meier analysis revealed slightly worse survival with more RFs (No RFs: 90.9%, 79.3%, and 62.8%; 1 RF: 89.5%, 74.8%, and 59.3%; 2 RFs: 89.2%, 74.5%, and 56.9%; 3+ RFs: 86.9%, 73.6%, and 58.8% for 1, 5, and 10 year survival for all groups; p< 0.01) (Figure). The Cox proportional model revealed decreased survival based on the RFs (1 RF: Hazard ratio [HR] 1.16, 95% Confidence Interval [CI] 1.10-1.23; 2 RFs: HR 1.20, CI 1.11-1.31; 3+ RFs: HR 1.36, 1.19-1.55; p<0.01 for all groups). Donors with more risk factors were associated with slightly worse outcomes following heart transplant. While differences were statistically significant, careful selection of both recipients and donors with risk factors at appropriate centers may increase utilization of donor hearts.