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Impact of Deceased Donor Management on Donor Heart Use and Recipient Graft Survival.

Impact of Deceased Donor Management on Donor Heart Use and Recipient Graft Survival. Journal of the American College of Surgeons Swanson, E. A., Adams, T. n., Patel, M. S., De La Cruz, S. n., Hutchens, M. n., Khush, K. n., Sally, M. n., Niemann, C. U., Groat, T. n., Malinoski, D. n. 2020

Abstract

Current risk-adjusted models used to predict donor heart utilization and cardiac graft survival from organ donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart utilization and graft survival to better understand the relationship between donor management and transplant outcomes.Prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at three standardized time points during donor management. The primary outcome measures were donor heart utilization and cardiac graft survival.From 3,433 DBDs, 1,134 (33%) hearts were transplanted and 969 (85%) cardiac grafts survived after 684 (± 392) days of follow-up. After multivariable analysis, independent positive predictors of heart utilization included standard criteria donor status (OR = 3.93), male sex (OR = 1.68), ejection fraction > 50% (OR = 1.64), and PaO2:FiO2 > 300 (OR = 1.31). Independent negative predictors of heart utilization included donor age (OR = 0.94), body mass index > 30 kg/m2 (OR = 0.78), serum creatinine (OR = 0.83), and use of thyroid hormone (OR = 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR = 1.04 per µg/hr).Modifiable critical care parameters and treatments predict donor heart utilization and cardiac graft survival. The discordant relationship between thyroid hormone and donor heart utilization (negative predictor) versus cardiac graft survival (positive predictor) warrants further investigation.

View details for DOI 10.1016/j.jamcollsurg.2020.05.025

View details for PubMedID 32562768