Arezu Z Aliabadi-Zuckermann1, Johannes Gökler2, Alexandra Kaider3, Julia Riebandt2, Roxana Moayedifar2, Emilio Osorio2, Thomas Haberl2, Phillipp Angleitner2, Günther Laufer2, John Forsythe4, Ivan Knezevic5, Bosko Skoric6, Michiel Erasmus7, Johan van Cleemput8, Kadir Caliskan9, Nicolaas De Jonge10, Zoltan Szabolcs11, Zsolt Prodán12, Andrä Wasler13, Christoph Bara14, Mario Udovičić15, Tim Sandhaus16, Jens Garbade17, Arjang Ruhparwar18, Felix Schoenrath19, Stephan Hirt20, Herwig Antretter21, Uwe Schulz22, Manfred Richter23, Josef Thul24, Markus J Barten25, Assad Haneya26, Ivan Aleksic27, Sandra Eifert28, Michael Berchtold-Herz29, Jacqueline Smits30, Andreas O Zuckermann2. 1. Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: arezu.aliabadi-zuckermann@meduniwien.ac.at. 2. Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. 3. Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. 4. Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK. 5. Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia. 6. Department of Cardiovascular Diseases, University of Zagreb School of Medicine, Zagreb, Croatia. 7. Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 8. Department of Cardiology, University Hospitals Leuven, Leuven, Belgium. 9. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. 10. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. 11. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. 12. Department of Pediatric Heart Surgery, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 13. Division for Transplantation, Department of Surgery, Medical University of Graz, Graz, Austria. 14. Division of Thoracic Transplantation and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. 15. Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb, Croatia. 16. Friedrich Schiller University of Jena, Jena, Germany. 17. Department of Cardiac Surgery, University Hospital Leipzig, Heart Center Leipzig, Leipzig, Germany. 18. Cardiac Surgery Clinic, University of Heidelberg, Heidelberg, Germany. 19. Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. 20. University of Regensburg, Regensburg, Germany. 21. Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria. 22. Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany. 23. Kerckhoff Clinic, Department of Cardiac Surgery, Bad Nauheim, Germany. 24. Pediatric Heart Center, Justus-Liebig University, Giessen, Germany. 25. Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany. 26. Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany. 27. Department of Cardiothoracic Surgery, Zentrum Operative Medizine, University of Würzburg, Würzburg, Germany. 28. Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany. 29. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Germany. 30. Eurotransplant International Foundation, Leiden, The Netherlands.
Abstract
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 2015. RESULTS: 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.
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 2015. RESULTS: 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.
Authors: Yasuhiro Shudo; Aiman Alassar; Hanjay Wang; Bharathi Lingala; Hao He; Yuanjia Zhu; William Hiesinger; John W MacArthur; Jack H Boyd; Anson M Lee; Maria Currie; Y Joseph Woo Journal: Transpl Int Date: 2022-03-10 Impact factor: 3.782