Korean Circ J.  2023 Apr;53(4):254-267. 10.4070/kcj.2022.0197.

The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience

• Lee SY
• Kim SH
• Ju MH
• Lim MH
• Lee Ch
• Je HG
• Lim JH
• Kim GY
• Oh JS
• Choi JH
• Chon MK
• Lee SH
• Hwang KW
• Kim JS
• Park YH
• Kim JH
• Chun KJ

• KMID: 2542296
• DOI: http://doi.org/10.4070/kcj.2022.0197

Abstract

Background and Objectives
Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx.
Methods
Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed. MD was defined as follows; a donor age >55 years, left ventricular ejection fraction <50%, cold ischemic time >240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10).
Results
A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01).
Conclusions
The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and longterm outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.

Keyword

Heart transplantation; Transplant donors; Selection; Survival

Figure

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  Figure 1 Inclusion criteria and classification of each group by definition of marginal donor.HTx = heart transplant; LVEF = left ventricular ejection fraction; MD = marginal donor; NMD = non-marginal donor.

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  Figure 2 Trend of postoperative vasoactive inotropic scores and cardiac index in each group.(A) Vasoactive inotropic score of immediate, 6 hours and peak value within 24 hours post operation. (B) Serial cardiac index within 72 hours post operation.MD = marginal donor; NMD = non-marginal donor.

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  Figure 3 Overall survival and left ventricular function during follow up period.(A) Overall long-term survival between groups. (B) Long-term follow-up LVEF between groups.LVEF = left ventricular ejection fraction; MD = marginal donor; NMD = non-marginal donor.*p values were derived from independent t-test. †p values were derived from the Mann-Whitney test. Shapiro-Wilk’s test was employed for the test of the normality assumption.

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  Figure 4 Kaplan–Meier survival curve by donor and recipient medical status.(A) Survival rate in the low-risk recipient (IMPACT score <10) group. (B) Survival rate in the high-risk recipient (IMPACT score ≥10) group. (C) Survival rate in NMD group. (D) Survival rate in MD group.IMPACT = Index for Mortality Prediction after Cardiac Transplantation; MD = marginal donor; NMD = non-marginal donor.

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