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Primary heart dysfunction is greater with combined heart and lung compared with isolated heart procurement

Institution:	1. Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel;2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel;4. Cedars-Sinai Heart Institute and David Geffen School of Medicine at the University of California, Los Angeles, Calif;1. Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio;2. Cleveland VA CV Research Group, Cleveland, Ohio;3. Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio;4. Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland Medical Center, Cleveland, Ohio;5. Department of Cardiac Surgery, John Hopkins School of Medicine, Baltimore, Md

Abstract:	ObjectiveCombined heart and lungs (CHL) procurement differs from isolated heart (IH) procurement in several aspects, including lung recruitment, cannulation, and preservation requirements. We aimed to investigate whether CHL versus IH procurement contributes to the development of primary graft dysfunction (PGD) after heart transplantation (HT).MethodsBetween 1999 and 2019, we assessed 175 patients undergoing HT at a single center. Patients were divided into IH (n = 61) or CHL (n = 114) procurement groups. End points included PGD (defined according to the International Society for Heart and Lung Transplantation consensus statement) and long-term survival.ResultsThe incidence of PGD was significantly greater in CHL recipients compared with IH recipients (53.5% vs 16.4%, P < .001). Multivariable analysis showed that CHL procurement was independently associated with a significant 4.6-fold increased risk for PGD (95% confidence interval, 2.1-11, P < .001). Univariable and multivariable analyses showed that the overall survival was not significantly affected by the procurement group (log-rank P = .150, hazard ratio, 1.13; 95% confidence interval, 0.68-1.88, P = .646). The simultaneous procurement of abdominal organs was not associated with an increased risk of PGD in HT recipients. These results remained consistent in a propensity-matched analysis.ConclusionsCombined procurement of heart and lungs is independently associated with an increased risk of PGD. Further prospective studies are needed to validate this hypothesis-generating study.

Keywords:	heart transplantation multiple organ procurement primary graft dysfunction lung procurement combined heart and lungs CHL"} {"#name":"keyword" "$":{"id":"kwrd0020"} "$$":[{"#name":"text" "_":"combined heart and lungs CI"} {"#name":"keyword" "$":{"id":"kwrd0030"} "$$":[{"#name":"text" "_":"confidence interval HR"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"hazard ratio IH"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"isolated heart ISHLT"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"International Society for Heart and Lung Transplantation LV"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"left ventricle OR"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"odds ratio ORPD"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"organs recovered per donor PGD"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"primary graft dysfunction
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