TY - JOUR
T1 - Donor heart selection and outcomes
T2 - An analysis of over 2,000 cases
AU - Aliabadi-Zuckermann, Arezu Z.
AU - Goekler, Johannes
AU - Kaider, Alexandra
AU - Riebandt, Julia
AU - Moayedifar, Roxana
AU - Osorio, Emilio
AU - Haberl, Thomas
AU - Angleitner, Phillipp
AU - Laufer, Guenther
AU - Forsythe, John
AU - Knezevic, Ivan
AU - Skoric, Bosko
AU - Erasmus, Michiel
AU - van Cleemput, Johan
AU - Caliskan, Kadir
AU - De Jonge, Nicolaas
AU - Szabolcs, Zoltan
AU - Prodan, Zsolt
AU - Wasler, Andrae
AU - Bara, Christoph
AU - Udovicic, Mario
AU - Sandhaus, Tim
AU - Garbade, Jens
AU - Ruhparwar, Arjang
AU - Schoenrath, Felix
AU - Hirt, Stephan
AU - Antretter, Herwig
AU - Schulz, Uwe
AU - Richter, Manfred
AU - Thul, Josef
AU - Barten, Markus J.
AU - Haneya, Assad
AU - Aleksic, Ivan
AU - Eifert, Sandra
AU - Berchtold-Herz, Michael
AU - Smits, Jacqueline
AU - Zuckermann, Andreas O.
PY - 2018/8
Y1 - 2018/8
N2 - BACKGROUND: Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere.METHODS: This investigation was a retrospective analysis of data obtained from the University of Vienna Medical Center and Eurotransplant centers for the period 2001 to 2015RESULTS: Our center accepted 31.8% (699 of 2,199) of donor hearts offered. Unlike other centers, the acceptance rate, with or without transplantation, did not increase over time. Of the donor hearts rejected by our center, 38.1% (572 of 1,500) were later accepted elsewhere. Acceptance rates were twice as high for donor hearts initially rejected for non-quality reasons (339 of 601, 56.4%) compared with initial rejection for quality reasons (233 of 899, 25.9%). Three-year patient survival rate was 79% at Vienna; for donor hearts initially rejected by Vienna for non-quality reasons or quality reasons, it was 73% and 63%, respectively (p <0.001). Outcomes at other centers after transplantation of grafts rejected by Vienna varied according to the reason for rejection, with good 3-year survival rates for rejection due to positive virology (77%), high catecholamines (68%), long ischemic time (71%), or low ejection fraction (68%), but poor survival was observed for hearts rejected for hypernatremia (46%), cardiac arrest (21%), or valve pathology (50%).CONCLUSIONS: A less restrictive policy for accepting donor hearts at our center, particularly regarding rejection for non-quality reasons or for positive virology, high catecholamine levels, longer ischemic time, or low ejection fraction, could expand our donor pool while maintaining good outcomes. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.
AB - BACKGROUND: Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere.METHODS: This investigation was a retrospective analysis of data obtained from the University of Vienna Medical Center and Eurotransplant centers for the period 2001 to 2015RESULTS: Our center accepted 31.8% (699 of 2,199) of donor hearts offered. Unlike other centers, the acceptance rate, with or without transplantation, did not increase over time. Of the donor hearts rejected by our center, 38.1% (572 of 1,500) were later accepted elsewhere. Acceptance rates were twice as high for donor hearts initially rejected for non-quality reasons (339 of 601, 56.4%) compared with initial rejection for quality reasons (233 of 899, 25.9%). Three-year patient survival rate was 79% at Vienna; for donor hearts initially rejected by Vienna for non-quality reasons or quality reasons, it was 73% and 63%, respectively (p <0.001). Outcomes at other centers after transplantation of grafts rejected by Vienna varied according to the reason for rejection, with good 3-year survival rates for rejection due to positive virology (77%), high catecholamines (68%), long ischemic time (71%), or low ejection fraction (68%), but poor survival was observed for hearts rejected for hypernatremia (46%), cardiac arrest (21%), or valve pathology (50%).CONCLUSIONS: A less restrictive policy for accepting donor hearts at our center, particularly regarding rejection for non-quality reasons or for positive virology, high catecholamine levels, longer ischemic time, or low ejection fraction, could expand our donor pool while maintaining good outcomes. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.
KW - heart transplantation acceptance
KW - quality
KW - survival
KW - donor hear
KW - CARDIAC-ARREST
KW - INTERNATIONAL SOCIETY
KW - TRANSPLANTATION
KW - RECIPIENT
KW - SURVIVAL
KW - CRITERIA
KW - IMPACT
KW - REGISTRY
KW - AGE
U2 - 10.1016/j.healun.2018.04.014
DO - 10.1016/j.healun.2018.04.014
M3 - Article
SN - 1053-2498
VL - 37
SP - 976
EP - 984
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 8
ER -