Donor-transmitted coronary atherosclerosis.

BACKGROUND: Autopsies show that coronary atherosclerosis is present frequently in the young and healthy. However, according to our former guideline, we performed pre-transplant evaluation without coronary angiogram in donors <60 years. The purpose of this study is to evaluate to what extent native coronary atherosclerosis is transmitted through heart transplantation. METHODS: Between April 1986 and December 2000, a total of 1253 patients underwent heart transplantation at our institution. If coronary evaluation with coronary angiogram or autopsy had been performed within 6 months after transplantation, we regarded focal and non-circumferential atherosclerosis with >or=50% stenosis in proximal segments of at least 1 coronary vessel of the donor heart as transmitted, native coronary atherosclerosis, rather than newly developed transplant vasculopathy. RESULTS: We excluded 85 of 1253 (6.8%) cases because coronary evaluation was not performed within 6 months (n = 45) or because hearts underwent angiography during pre-transplant evaluation (n = 40). Of these, 2 patients with significant coronary atherosclerosis underwent transplantation and concurrent coronary artery bypass grafting. The prevalence of significant (stenosis >or=50%) and inadvertently transmitted coronary atherosclerosis was 7.0% (82/1168). CONCLUSION: The prevalence of coronary atherosclerosis in patients who underwent angiography within 6 months after transplantation was 5.2% (49/950). Among subjects who had autopsies within the first 6 months after heart transplantation, we found significant coronary atherosclerosis (stenosis >or=50%) 15.1% (33/218), and among those with early graft failure (<10 days after transplantation), the prevalence was 22.8% (26/114).The prevalence of coronary atherosclerosis in the donor pool is high, and donor screening without coronary angiogram overlooks significant coronary atherosclerotic lesions (stenosis >or=50%) in a considerable number of cases (7.0%). Because donor-transmitted coronary atherosclerosis is a risk factor in short-term (early graft failure) survival after heart transplantation, we have now changed our policy to include coronary angiography as a standard in screening donors >or=40 years. However, to what extent donor coronary atherosclerosis is accepted undoubtedly must be made arbitrarily until an evidence-based algorithm becomes available.     

Results after transplantation using donor hearts with preexisting coronary artery disease

OBJECTIVE: Cardiac allografts with coronary artery disease may permit a selective expansion of the donor pool. Twenty-two recipients who received donor hearts with mild to moderate coronary artery disease on angiography were reviewed. All donor organs had preserved left ventricle function on echocardiogram. METHODS: The procedure was explained to the patients in detail. All survivors have at least 1 year of follow-up. If the coronary arteries of the donor heart were significantly occluded, then the implanting surgeon performed coronary revascularization. Donors were allocated to patients facing imminent death (group I, n = 4) or to those who would otherwise not have been transplanted (group II, n = 18). Median recipient age was 57 years old for group I and 68 years old for group II. Median follow-up was 25 months for group I and 44 for group II. RESULTS: Outcome was evaluated using survival and freedom from graft coronary disease as end points. In group I, 3 of the 4 hearts required revascularization. In group II, 10 of the 18 required revascularization. The majority of the revascularizations were recipient saphenous vein grafts (84.6%) to the donor left anterior descending artery (50%). The 1-month and 2-year actual survivals for group I are 75% and 50% and 87.5% and 81.3 for group II. One patient in group I who was in extremis and 3 in group II died at less than 90 days. Group II early deaths had donor risk factor combinations of coronary artery disease, left ventricular hypertrophy, and long distance. Freedom from new graft coronary artery disease was 100% at 2 years in group I and 87.5% in group II. CONCLUSIONS: Selective use of donor hearts with coronary artery disease is acceptable. Early deaths are related to recipient factors as well as associated donor risk factors. Donor hearts with mild or moderate coronary artery disease and preserved function on echocardiogram can be used but may require revascularization with recipient conduit and/or percutaneous transluminal coronary artery angioplasty. Coronary disease in donor hearts requires grading and does not categorically preclude use, particularly in risk-matched recipients.     

Arresting donor hearts with extracellular-type cardioplegia prevents vasoconstriction induced by UW solution.

The effects of arresting donor hearts with University of Wisconsin solution was investigated. Donor dogs were divided into two groups according to the technique used for arresting the heart. In group I (n = 6) the heart was arrested with University of Wisconsin solution, whereas in group II (n = 6) extracellular-type cardioplegia (K+ = 20 mmol/liter) was used to induce cardioplegic arrest. Aortic root pressure was measured during the infusion of solution at constant flow. In both groups, the hearts were then flushed and stored in cold University of Wisconsin solution for 6 h. The hearts were transplanted orthotopically and disconnected from cardiopulmonary bypass. Left ventricular function was evaluated by pressure-volume relations using a conductance catheter. Peak aortic root pressure during the infusion was significantly higher in group I than in group II, although post-transplant left ventricular function was similar in both groups. Although there was no difference in cardiac function after implantation, donor hearts should be arrested by extracellular-type cardioplegia to prevent coronary vasoconstriction associated with preservation in University of Wisconsin solution.     

Use of hearts transplanted from donors with atraumatic intracranial bleeds.

BACKGROUND: Donor atraumatic intracranial bleed (aICB) is associated with older age and may reflect a history of hypertension. Hearts from donors who died of aICB may be at increased risk for graft failure because of the associated catecholamine surge. We evaluated whether receiving a heart from a donor who had an aICB independently affected the outcome of transplantation. METHODS: We reviewed adult patients (>18 years) who underwent heart transplantation between July 1994 and December 1999. We excluded patients who received non-standard hearts (e.g., donor age >55 years). Group 1 received hearts from donors with aICB (n = 80), and Group 2 received hearts from donors who did not have aICB (n = 171). RESULTS: Recipient age, gender, United Network for Organ Sharing status, and indication for transplantation were similar for both groups. Donors in Group 1 were older (41 vs 26 years, p = 0.001), more commonly women (55% vs 20%, p = 0.001), and more often had history of hypertension (26% vs 2%, p = 0.001). Survival to discharge was 86% in Group 1 and 95% in Group 2. Actuarial 5-year survival was 72% for Group 1 and 81% for Group 2 (p = 0.52). Regression analysis showed that receiving a heart from a donor with aICB was a risk factor for early recipient mortality but not for long-term outcome (odds ratio = 3.25, p = 0.02, and hazard ratio = 1.16, p = 0.69, respectively). Donor aICB, female gender, and abnormal initial echocardiogram (global hypokinesia) were selected as clinically relevant independent risk factors for early mortality of the recipient, using a fitted multifactor logistic regression model (goodness-of-fit chi-square p value = 0.94). Donor age, accident-to-retrieval time interval, and borderline left ventricular hypertrophy did not significantly differ. Five-year freedom from transplant coronary artery disease in Group 1 was 74% (vs 80% in Group 2, p = 0.05). CONCLUSIONS: The trend observed in this series suggests that receiving a heart from a donor with aICB is a potential independent risk factor for early mortality after transplantation independent of age. Caution should be used when evaluating such donors, particularly when other risk factors such as female donor or depressed ejection fraction are present.     

Long-term survival of cardiac xenografts in fully xenogeneic (mouse --> rat) bone marrow chimeras

BACKGROUND: The shortage of human hearts remains a major barrier to the efficacy of heart transplantation for the treatment of end-stage heart disease. One potential solution to the supply problem would be the use of hearts from nonhuman donors (xenografts). We have established a model of mouse to rat xenogeneic bone marrow chimerism, and in this study we have hypothesized that such chimeric rats will accept both donor and recipient specific heart grafts while rejecting third-party mouse and rat grafts. We also investigated humoral responses in naive and chimeric rats with and without donor murine cardiac grafts. METHODS: Recipient Lewis rats (n = 22) were given 1100 cGy lethal total body irradiation and the same day received 300 x 10(6) donor B10.BR mouse bone marrow cells intravenously. Peripheral blood of surviving rats (n = 18) was typed at 4 weeks and then monthly thereafter. Donor and recipient specific and third-party heterotopic heart transplantations were performed at 6 to 8 weeks after reconstitution with bone marrow. RESULTS: Multilineage bone marrow chimerism was produced in all experimental animals with complete replacement of recipient marrow by donor cells. Murine donor and rat recipient strain hearts transplanted in chimeric rats survived indefinitely. Third-party rat and mouse hearts were rejected, though at a slower rate than bone marrow matched naive controls. High levels of antimouse antibodies were detected in rats with rejected hearts. These antibodies were absent in chimeric animals with long-term surviving heart grafts. CONCLUSIONS: Long-term multilineage bone marrow chimerism can be produced in a mouse --> rat bone marrow transplant model. Long-term survival of donor specific and recipient specific vascularized cardiac grafts can be produced in these chimeric animals. These animals are clinically normal but show signs of subclinical immunosuppression regimen as they reject third-party hearts later than naive animals. Our results suggest that antibodies also play a significant role in concordant xenograft rejection, and induction of bone marrow chimerism can overcome this barrier.     

Fate of bypass grafts onto totally occluded coronary arteries.

BACKGROUND: Chronically occluded coronary arteries often develop good collateralisation, that leads to retrograde perfusion of these vessels, as regularly seen in coronary angiograms. Retrograde perfusion constitutes a form of competitive flow, which in turn is associated with an increased risk for early bypass graft failure. The aim of our study is to investigate the patency rate of bypass grafts onto totally occluded coronary arteries, in the presence of retrograde flow. METHODS: Two groups of patients were followed up by cardiac catheterisation. One month after undergoing coronary artery bypass grafting. Group 1 (n=33) had coronary three vessel disease, with one totally occluded coronary artery and evidence of retrograde flow in the preoperative coronary angiogram. Group 2 (n=30) was the control group, with coronary three vessel disease and without totally occluded coronaries. We used internal mammary arteries and saphenous vein grafts as conduits. RESULTS: Thirty-six point thirty-six per cent of bypass grafts onto totally occluded coronaries were occluded one month postoperatively (n=12). Graft failure in the control group was 13.3%. Significance p=0.03. CONCLUSIONS: In view of our findings we conclude, that there is a significantly increased incidence of early graft failure, when totally occluded coronary arteries are revascularised, that show retrograde flow in the preoperative coronary angiogram.     

Donor cause of death and medium-term survival after heart transplantation: a United Kingdom national study

OBJECTIVE: Donor cause of death may be a risk factor for early mortality after heart transplantation, but its effect on medium-term survival is uncertain. METHODS: By means of a national prospective database, we investigated the influence of donor cause of death on survival to 3 years in 1254 adult recipients of cadaveric heart transplantation between July 1995 and June 2002. Donor cause of death was categorized a priori as vascular and tumor (group V, n = 739), trauma (group T, n = 407), hypoxic (group H, n = 82), and infective causes (group I, n = 26). Risk factors for early (30-day), late (30-day to 3-year), and overall mortality were identified with Cox regression. RESULTS: Group V donors were more likely to be older ( P < .001) and female ( P < .001). There were 297 deaths in the 3-year period, and the unadjusted 3-year survivals varied significantly (group V 73%, group T 79%, group H 85%, group I 80%, P = .01). Cox analysis identified donor age, organ ischemia time, recipient creatinine clearance, recipient diagnosis, peripheral vascular disease, ventilation, diabetes, and donor-recipient size mismatch as risk factors for early, late, or overall mortality ( P < .10). After adjustment for these factors, donor cause of death was no longer a significant predictor of recipient death (early death P = .36, late death P = .79, overall mortality P = .37). CONCLUSION: We confirmed that there is an apparent association between cause of donor death and posttransplantation survival, but this was not maintained after adjustment for confounding variables. Donor cause of death therefore should not influence donor organ acceptance or donor-recipient matching and does not identify marginal donors.     

Postinfarct ventricular septal defect repair: effect of coronary artery bypass grafting.

Between June 1968 and April 1991, 75 patients who had undergone coronary angiography underwent repair of a postinfarction ventricular septal defect. Group 1 (n = 33) includes patients who had two- or three-vessel serious (> 75% narrowing) proximal coronary artery disease and underwent complete revascularization in addition to repair of the ventricular septal defect. Group 2 (n = 19) patients also had two- or three-vessel coronary artery disease but bypass grafting was not performed; only the ventricular defect was repaired. Group 3 (n = 23) patients had only single-vessel coronary artery disease that corresponded to the region of the infarct; they underwent ventricular septal defect repair only. Follow-up of hospital survivors was 96% complete at a mean of 86.2 months (range, 1 to 288 months). Hospital mortality after ventricular septal defect repair was 21.2% in the cohort with bypassed coronary artery disease (group 1), 26.3% in those with unbypassed disease (group 2), and 26.1% in those with only single-vessel coronary artery disease (group 3) (p = 0.88). With follow-up after 5 and 10 years, the actuarial survival was 72.2% +/- 8% and 47.8% +/- 10%, respectively, in the bypassed group, 29.2% +/- 11% and 0%, respectively, in the unbypassed group, and 52.2% +/- 10% and 36.5% +/- 11%, respectively, in the cohort with single-vessel disease. Bypassing associated coronary artery disease significantly increased long-term survival when compared with patients with unbypassed coronary artery disease (p = 0.0015).     

TGF-β1转基因对大鼠心脏移植物缺血-再灌注损伤的影响

目的 观察转化生长因子-β1(TGF.β1)转基因对大鼠移植心脏缺血-再灌注损伤的影响.方法 利用Cuff技术建立心脏移植模型,转基冈组供心离体灌注携带mTGF-β1基因腺病毒颗粒;空白对照组灌注停跳液;空载体组灌注空白载体腺病毒颗粒.观察移植物超微结构变化;RT-PCR检测心肌组织mTGF-β1mRNA的转录强度;测定心肌组织中超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量、髓过氧化物酶(MPO)活性.结果 转基因组心肌组织有外源性mTGF-β1基凶及蛋白表达,心肌细胞凋亡显著减少、SOD活性升高、MDA含量和MPO活性下降.结论 TGF-β1基因能减轻移植心脏缺血.再灌注损伤.     

Alloimmune-mediated vascular remodeling of human coronary artery grafts in immunodeficient mouse recipients is independent of preexisting atherosclerosis

Vascular remodeling rather than intimal thickening is the most important determinant of luminal loss in cardiac graft arteriosclerosis. The impact of donor-transmitted atherosclerotic lesions on alloimmune-mediated arterial injury in an experimental setting is not known. We investigated this issue in a chimeric model of human coronary artery grafts to immunodeficient mouse recipients reconstituted with allogeneic human peripheral blood mononuclear cells. Rejecting grafts demonstrated robust intimal expansion, outward vascular remodeling, and variable lumen loss. There was no significant relationship between preexistent atherosclerosis, gender, and age of the artery donors vs. the degree of alloimmune-induced changes in vessel morphology. Our experimental findings, in a system without the potentially confounding variable of immunosuppressive drugs, are in agreement with the majority of clinical studies that alloimmune-mediated intimal injury and vascular remodeling is independent of preexisting coronary atherosclerosis. Our results support the concept of extending the criteria for organ donors to include modest coronary atherosclerosis.     

Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia.

Donor hypernatremia was reported to cause postoperative graft dysfunction in human orthotopic liver transplantation (OLT). However, the effects of the correction of donor hypernatremia before organ procurement have not been confirmed. The aim of this study is to determine whether donor hypernatremia is associated with early graft dysfunction after OLT and to determine the effect of the correction of donor hypernatremia. One hundred eighty-one consecutive OLTs performed between May 1997 and July 1998 were entered onto this study. The cases were divided into three groups according to the donor serum sodium concentration: group A, serum sodium of 155 mEq/L or less before organ procurement (n = 118); group B, peak sodium greater than 155 mEq/L and final sodium 155 mEq/L or less (n = 36); and group C, final sodium greater than 155 mEq/L (n = 27). Graft survival within 90 days after OLT and early postoperative graft function were analyzed. There were no significant differences in donor and recipient variables among the three groups. The frequencies of graft loss were 15 of 118 grafts (12.7%) in group A, 4 of 36 grafts (11.1%) in group B, and 9 of 27 grafts (33.3%; P <.05 v groups A and B) in group C. The liver enzyme values in groups B and C were significantly greater than those in group A postoperatively. The prothrombin times of group C were significantly longer than those of group A for the first 4 postoperative days. Recipients of hepatic allografts from donors with uncorrected hypernatremia had a significantly greater incidence of graft loss compared with recipients of hepatic allografts from normonatremic donors. However, the differences in graft survival were abrogated by the correction of donor hypernatremia before procurement.     

Older liver graft transplantation, cholestasis and synthetic graft function

Older liver grafts are often discarded because of conservative selection criteria. We report on our clinical experience with graft-age related outcome. Patients transplanted with livers older than 70 years (70.2-80.2 years, n = 38) were compared with controls transplanted with livers younger than 70 years. Pairs were matched for age, gender, indication and cold ischemic time. Mean donor age was 73.4 +/- 2 vs. 39 +/- 16 years. Patient and graft survival did not differ between both groups after 1-year follow-up (P = 0.19 and P = 0.24 respectively). Retransplantation rate was 10.5% vs. 5.3% (P = 0.40). Initial poor function occurred in two patients in the study group versus four patients in the control group (P = 0.69). The incidence of rejection episodes was comparable. Parameters of cholestasis and protein synthesis showed no difference 1-year post-transplant. Mean age of donor organs in matched pairs group B was near by half of that in the older donor group A (39.0 vs. 73.4 years). Post-transplant outcome as indicated by patient and graft survival was comparable between both groups. Donor organ age had no impact on postoperative organ function. We recommend to accept liver grafts from organ donors older than 70 years to expand the donor pool.     

超声二维应变评价冠状动脉介入治疗后左心室心肌收缩功能

目的应用超声二维应变（2DS）技术观察单支和多支冠状动脉病变心绞痛患者经皮冠状动脉介入治疗（PCI）后左心室局部心肌径向收缩功能改变有无差异。方法将63例心绞痛患者根据冠状动脉造影结果分为单支病变组（n=33）和多支病变组（n=30）,另选志愿者30名作为正常对照组,分别记录PCI术前、术后3个月及正常对照组左心室基底水平、乳头肌水平及心尖部水平18个室壁节段的二维灰阶图像。应用GE Echo PAC软件测量左心室短轴各室壁节段收缩期峰值径向应变。结果与正常对照组比较,单支病变组和多支病变组PCI术前大部分心肌节段和术后3个月部分心肌节段的左心室收缩期短轴峰值径向应变减低（P〈0.05）;单支病变组PCI术后3个月73.51%（136/185）心肌缺血节段恢复到正常水平,与多支病变组54.11%（158/292）差异有统计学意义（P〈0.01）。结论不同冠状动脉病变心绞痛患者PCI术后左心室径向收缩功能改善情况有所不同。     

HOE-642联合尼可地尔对无心跳猪供心的保护作用

目的 探讨无心跳供者(NHBD)的心脏进行移植的可行性,以及HOE-642联合尼可地尔对这种供心的保护效果.方法 将健康雄性家猪随机分为实验组和对照组,实验组供者采取主动脉快速完全放血法制成NHBD模型,取其心脏,冷保存4 h后进行移植;对照组供者经主动脉适量放血(仍有心跳),造成热缺血,然后取其心脏,冷保存4 h后进行移植.实验组于供心热缺血前5 min静脉给予HOE-642(2 mg/kg);以含HOE-642和尼可地尔的4 ℃ Stanford液灌洗和保存供心;供心吻合前经主动脉根部以含HOE-642和尼可地尔的4 ℃ 4:1血心停搏液(高钾)灌注1次;供心吻合期间以含HOE-642和尼可地尔的4 ℃ 4:1血心停搏液(低钾)间断灌注;心脏吻合完毕主动脉开放后初始5 min时段内,静脉给予HOE-642(2 mg/kg).对照组的供心处理除不用HOE-642和尼可地尔外,其余同实验组.采集供心主动脉根部放血前、移植心脏吻合完毕主动脉开放后1 h(停机)以及主动脉开放后2 h(实验结束)3个时点的心脏血流动力学指标,测定移植心脏的心肌含水量,观察心肌的组织学变化.结果 两组在主动脉开放后心肌红润,心脏搏动有力,均成功脱机.两组各检测时点的左心室舒张末压、左心室峰发展压及左心室压力变化速率的差异均无统计学意义(P＞0.05);实验组和对照组心肌组织含水量分别为(78.6±5.7)%和(76.4±4.2)%,其差异无统计学意义(P＞0.05);光镜下见两组的心肌纤维结构清楚,排列紧密,间质未见炎症细胞浸润,也未见变性、坏死,无排斥反应征象,电镜下见心肌细胞超微结构完整.结论 NHBD的供心可用于移植,其效果与有心跳者相近;HOE-642和尼可地尔联用可能对该类供心具有一定的保护作用.     

Prolonged donor ischemic time does not adversely affect long-term survival in adult patients undergoing cardiac transplantation

OBJECTIVE: With liberalization of donor eligibility criteria, organs are being harvested from remote locations, increasing donor ischemic times. Although several studies have evaluated the effects of prolonged donor ischemic times on short-term survival and graft function, few have addressed concerns regarding long-term survival. METHODS: Over the last 11 years, 819 consecutive adults underwent cardiac transplantation at Columbia Presbyterian Medical Center. Recipients were separated into the following 4 groups based on donor ischemic time: <150 minutes, 150 to 200 minutes, 200 to 250 minutes, and >250 minutes. Statistical analysis included Kaplan-Meier survival and Cox proportional hazard models to identify predictors of long-term survival. RESULTS: Donor ischemic time was 120.1 +/- 21.1 minutes for group 1 (n = 321), 174.1 +/- 14.7 minutes for group 2 (n = 264), 221.7 +/- 14.6 minutes for group 3 (n = 154), and 295.5 +/- 37.1 minutes for group 4 (n = 80) (P <.001). There were no significant differences in recipient age, donor age, etiology of heart failure, United Network for Organ Sharing status, or history of previous cardiac surgery among the groups (P = NS). Prolonged donor ischemic time did not adversely affect long-term survival, with actuarial survival at 1, 5, and 10 years of 86.9%, 75.2%, and 56.4% for group 1; 86.2%, 76.9%, and 50.9% for group 2; 86.4%, 71.0%, and 43.7% for group 3; and 86.7%, 70.1%, and 50.9% for group 4 (P =.867). There was no significant difference in freedom from transplant coronary artery disease among the 4 groups (P =.474). CONCLUSIONS: Prolonged donor ischemic time is not a risk factor for decreased long-term survival. Procurement of hearts with prolonged donor ischemic time is justified in the setting of an increasing recipient pool with a fixed donor population.     

The use of donor hearts with left ventricular hypertrophy.

BACKGROUND: We reviewed 37 patients who received donor hearts with left ventricular hypertrophy (LVH) to determine which factors affected outcomes. METHODS: Thirty-seven patients underwent orthotopic heart transplantation (1994 through 1998) with donor hearts qualified as having LVH by echocardiography (EC) and/or electrocardiogram (ECG). We performed univariate analysis on 18 donor and recipient risk factors for mortality. We calculated 12-month survival curves using Kaplan-Meier estimates and compared them using the log-rank test. A contemporaneous cohort of 221 patients who received optimal hearts within the same institution served as a control for survival. RESULTS: Median follow-up was 18 months (1 to 53). Median recipient age was 58 ye ars (25 to 75), and median donor age was 47 years (12 to 63). Median donor/recipient height and weight ratios were 1.01 (0.9 to 1.19) and 1.16 (0.77 to 2.02), respectively. Two-month survival was 86.4%, and 12-month survival was 73.0%. Survival for the control group was 91. 6% at 2 months and 86.9% at 12 months. Clinically inferior survival curves were observed when donors had known hypertension (n = 17, 95% vs 71% at 2 months, 76% vs 65% at 12 months), ischemia > 180 minutes (n = 18, 95% vs 72% at 2 months, 78% vs 65% at 12 months), LVH by ECG (n = 10, 85% vs 80% at 2 months, 77% vs 56% at 12 months), and greater than mild or unknown ECHO grade (n = 18, 89% vs 72% at 2 months, 84% vs 59% at 12 months, p = 0.11). CONCLUSIONS: Donor hearts with mild LVH may be used selectively, particularly if there are no ECG criteria and if ischemia time is short. Caution is indicated for donors with documented history of hypertension. Precise measurement of LV wall thickness by EC is needed in all donors to estimate severity and to complement ECG interpretation.     

The impact of HLA sensitization and donor cause of death in heart transplantation

Current expansion of the recipient population and increased utilization of left ventricular assist devices as a bridge-to-transplantation have resulted in HLA sensitization becoming an increasingly important clinical problem in cardiac transplantation. We evaluated the impact of HLA sensitization and donor cause of death on survival in 500 cardiac transplant recipients. Donor cause of death was grouped into two categories, trauma and nontrauma. Panel reactive antibodies at the time of transplant were assayed and used as a marker for sensitization if more than 10%. Sensitized recipients had a poorer 1-year survival than those not sensitized (76 vs. 89%, respectively, P=0.2). Donor cause of death had an overall significant impact on survival with 1-year survival for recipients of trauma organs of 92 and 82% for recipients of nontrauma hearts (P=0.02). Trauma hearts transplanted into sensitized recipients yielded a survival of 93% at 1 year whereas if nontrauma donor hearts were transplanted into these recipients, survival was only 52% at 1 year, P<0.001. These intriguing results suggest that graft survival in HLA-sensitized recipients could be significantly improved through the use of hearts from trauma death donors.     

The effect of a donor's history of active substance on outcomes following orthotopic heart transplantation.

OBJECTIVE: To review the short-term and long-term outcomes of using heart donors with a history of substance abuse. METHODS: Retrospective chart review was performed of heart recipients over an 8-year span. Charts provided demographics, mechanisms of donor death, and history of substance abuse. Additionally, charts were quarried for post-operative echocardiography and coronary angiogram results, serologic tests, and survival. RESULTS: Between January 1997 and December 2005, 689 heart transplants were performed, 150 (21.8%) had a history positive for substance abuse. The mean donor age was 34.5 years (range 16-62 years); most common cause of death was traumatic head injury in 87 donors (58.0%). Most patients (76.0%) had a history of 1 ppd smoking for > or =5 years, 89 (59.3%) had a history of inhaled drug use, 75 (50.0%) alcohol abuse, and 12 (8.0%) intravenous drug use. At a mean follow-up of 8.3 days, 68 hearts (45.3%) had normal, 36 (24.0%) mild, 23 (15.3%) moderate, and 10 (6.7%) severe ventricular dysfunction by echocardiography. Furthermore, 110 hearts (73.3%) had normal coronaries, 20 (13.3%) had mild, and 2 (1.3%) had evidence of moderate coronary artery disease (CAD) on coronary angiogram at a mean follow-up of 9.8 months (range 0.1-43.7 months). All recipients who received organs from known hepatitis B, or C positive, donors converted to positive serologies. Overall post-transplant survival for the group was 89.8% at a mean follow up of 43.3 months (range 5.8-108.6 months). CONCLUSIONS: A history of donor substance abuse does not have a negative impact on overall survival, cardiac function, risk of transplant associated coronary artery disease (TCAD). In patients who receive organs from virus positive donors, the risk of viral conversion is high, but survival seems not to be influenced.     

Low Incidence of Coronary Angiography in the Evaluation Process of the Potential Heart Donor

IntroductionWe investigated the practice of coronary angiography (CA) on donor hearts.Patients and MethodsBetween January 1, 2000, and December 31, 2010, all reported organ donors aged <66 years were analyzed retrospectively. Donor charts were evaluated regarding a performed CA, its outcome, the timing of CA during the evaluation process, and reasons for organ refusal. The percentage of positive CA studies in organ donors aged ≥45 years was also evaluated.ResultsOf 292 reported organ donors, 152 organ donor hearts were declined (group 1), and 140 hearts (group 2) were transplanted. Of the 152 declined hearts, 91 hearts were found not suitable for organ offer, and 61 were not successfully allocated or were refused by Eurotransplant. CA was conducted in 17 organ donors (5.8%). In 6 donors, a previous CA was reported (all had pathologic findings), and in 11 donors, a donor CA was performed, indicating 4 pathologic and 7 negative findings (54.5% of the hearts evaluated by donor CA were transplanted). No complication or delay of the donation process was reportedly related to donor CA.ConclusionsSpecial emphasis and implementation of recommendations for CA to be part of the evaluation of donor organs seem necessary.