Thyroid Hormone Improved Heart Transplant Recipient Survival

Abstract

Purpose Studies have shown that thyroid hormone results in a higher number of organs available for transplant. The purpose of this study was to evaluate the effects of triiodothyronine (T3) and/or thyroxine (T4) on heart transplant recipient (HtxR) survival. Methods The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from March 1994 to March 2018 for donor hearts. After exclusions for multiorgan transplant and age (donor Results Donor age ranged from 15-73 y (mean 32y, median 30y), 70% were male. The mean donor ejection fraction (EF) was 61.6% (median 60%). The ischemic time ranged from 0.22-12 hours (h) (mean3.16h, median 3.13h). 37307 patients had T3/4 data available. 24358 (65%) patients were given T3 or T4 within 24h of procurement and 12949 (35%) were given neither. Donors who received T3/4 had 15% higher odds of 30 day survival (OR=1.15; p=0.033), translating adjusted 30 day survival probabilities into 95.8% for those receiving neither and 96.2% for those receiving either T3/4. However, 1 year survival was not significantly different (OR=1.06; p=0.123; 89.8% vs. 90.3%). Over more than 10 years there was a long-term survival benefit for recipients whose donors had received T3/4 within 24 hours of procurement (HR=0.95, p=0.009). The same effect was present for post-transplant rejection, although with a higher degree of uncertainty (HR=0.96, p=0.050). Conclusion Thirty day and long-term HtxR survival is improved when T3/4 is given to the donor within 24 hours of procurement. T3/4 should be a considered as an additional component of a donor management protocol.