Optimal Characteristics of Donor Hearts With Diminished Left Ventricular Function

Abstract

Purpose: Previous studies have shown that carefully selected donor hearts (DH) with left ventricular (LV) ejection fraction (EF) ≥ 30% may be transplanted with long-term survival equivalent to DH with normal LVEF. The purpose of this study is to facilitate the selection process. Methods: Using the UNOS database, we reviewed all adult heart transplants between 1/1/2000 and 3/31/2016. DH were divided into Group 1: LVEF 40-49.9% and Group 2: LVEF 30-39.9%. DH with LVEF < 30% or ≥ 50% were excluded other than for baseline comparisons. A Cox regression model for each group was developed to estimate post-transplant 1 year mortality and graft failure hazard ratios (HR) with 95% confidence intervals (95%CI). Covariates considered included donor and recipient age, gender, race and body mass index (BMI), and ischemic time (IT), cause of death and smoking status. Results: 31,979 DH were transplanted during the study period. 387 were excluded for no recorded LVEF and 31,010 for LVEF < 30% or ≥ 50%. When compared to DH with LVEF ≥ 50%, DH with reduced LVEF were slightly younger (Group 1: 29.6±11.3 SD, Group 2: 27.6±10.9 vs. LVEF≥ 50%: 32.1±12.0, p< 0.001 ANOVA) and had slightly lower BMI (26.2±5.3, 25.5±4.7 vs. 26.9±5.6, p< 0.001). There were no differencesin recipient characteristics. Hourly increments in IT were associated with significant HR for both 1 year mortality and graft failure in both Groups (table 1a&b). Using White recipient ethnicity as reference, DHs from Group 1 transplanted to African Americans (AA) were associated with similar HR for both mortality and graft failure (table 1a&b) as have been previously reported with the use of DH with LVEF≥ 50% in AA recipients. Conclusion: Hourly increases in IT of DH with LVEF between 30% and 50% are associated with significantly increased HR for both 1 year mortality and graft failure. Donor and recipient age, gender, BMI, cause of death and smoking status did not impact outcomes although there was a selection bias because DH with reduced LVEF were slightly younger and had lower BMI than DH with normal LVEF (Table presented).