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Donor Heart Diastolic Dysfunction: Do You Take This Heart for Transplantation?
Abstracts S43 8( 8)
8( 9)
Performing Coronary Angiography in High Risk Cardiac Donors Does Not Affect Renal Function in Kidney Recipients M. Lesouhaitier ,1 C. Legeai,2 E. Savoye,2 C. Cantrelle,2 I. Pipien,2 M. Macher,2 C. Vigneau,1 R. Dorent.2 1CHU Rennes, Rennes, France; 2Agence de la Biomédecine, Saint-Denis, France.
Donor Heart Diastolic Dysfunction: Do You Take This Heart for Transplantation? F. Liou , M. Kittleson, J. Patel, T. Aintablian, T. Kao, E. Kransdorf, D. Geft, D.H. Chang, L. Czer, D. Ramzy, J.A. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA.
Purpose: Coronary angiography (CA) is the gold standard for evaluation of coronary artery disease in potential multiorgan donors. The use of iodinated contrast medium has been associated with contrast-induced acute kidney injury and consequently could lead to delayed graft function (DGF) in kidney recipients. This study was designed to determine whether performing CA in donors affects early graft function in kidney recipients. Methods: From March 2012 to June 2014, all patients in France who received a kidney from a 45-70 year-old donor, susceptible to undergo CA, without contraindication for cardiac procurement and with at least one cardiovascular risk factor, were included. Kidney recipients of pre-emptive or multiorgan transplant, or who died within the first eight days post-transplant were excluded. A multivariate conditional logistic regression model stratified on the procurement hospital was developed to assess the association of donor CA with DGF by taking into account the center effect. Results: 892 kidneys from 483 donors were transplanted. DGF was reported in 45.6% of the 438 kidney recipients grafted with a kidney from the 257 donors without CA and in 38.9% of the 375 kidney recipients who received a kidney from the 217 donors with CA. Multivariate analysis showed that CA did not influence the risk of DGF (Table 1). CA did not increase the risk of primary non-function, the duration of DGF or of post-transplant hospital stay and did not affect graft function at one year (Table 2). Conclusion: These findings indicate that evaluation of potential multi-organ donors with CA does not affect early kidney graft outcomes.
Purpose: Donor heart selection for heart transplantation (HTx) is extremely variable. Donor hearts may have marginal features which have not been well characterized for post-HTx outcomes. We sought to determine if diastolic dysfunction (DD) in donor hearts is a risk factor for poor post-HTx outcome. Methods: Between 2007-2013, we assessed 381 pre-HTx donor hearts for DD, defined by Mitral Valve (MV) E/A ratio < 1. We identified 110 with available E/A measurements. Donors were divided into those with DD (n= 40) and those without, (MV E/A ≥ 1) (n= 70). All donor hearts had LVEF≥ 55%. Risk factors assessed by multivariate analysis included: DD, recipient age, donor age, status 1A at HTx, cytomegalovirus mismatch, pretransplant CAD, cold ischemic time > 4hr, creatinine > 1.5, pre-HTx hypertension, pre-HTx diabetes. Other endpoints assessed included 3-yr survival, freedom from cardiac allograft vasculopathy (stenosis ≥ 30%), freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE: Myocardial infarction, new CHF, angioplasty/stents, pacemaker insertion, stroke), 1-yr freedom from left ventricular dysfunction (LVEF ≤ 40%) and any-treated rejection. Results: By multivariate analysis, donor DD was not an independent predictor for 3-yr survival (P= 0.983, HR= 1.013, 95% CI [0.322,3.186]). Pts with donor DD had comparable 3-yr survival, freedom from CAV, and freedom from NF-MACE compared to those in the normal donor diastolic function group. 1-yr freedom from LV dysfunction and any-treated rejection were also comparable between the two groups. Of the pts with donor DD, 88.9% no longer had DD at 1-yr post-HTx. Conclusion: The use of donor hearts with DD does not predispose HTx pts to worse outcome.
Endpoints 3-Year Survival 3-Year Freedom from CAV 3-Year Freedom from NF-MACE 1-Year Freedom from LV Dysfunction 1-Year Freedom from Any-Treated Rejection
Normal Donor Diastolic Function (n= 70)
Donor Diastolic Dysfunction (n= 40)
Log-Rank P-Value
85.7% 80.7%
77.5% 81.4%
0.214 0.861
85.7%
90.2%
0.470
90.3%
96.2%
0.286
88.9%
88.4%
0.818
9( 0)
Does Distance from Donor Hospital Impact Survival in Heart Transplant Recipients? Y. Ravi ,1 E.M. Stock,2 S.K. Lella,3 J.V. Balasubramaniyan,4 S. Emani,5 C.B. Sai-Sudhakar.1 1Cardiac Surgery, Scott & White, Texas A&M, Temple, TX; 2Center for Applied Health Research, US Department of Veteran Affairs, Perry Point, MD; 3Texas A&M Health Science Centre College of Medicine, Temple, TX; 4Cardiology, Sri Ramachandra University, Chennai, India; 5Internal Medicine, The Ohio State University, Columbus, OH. Purpose: With current changes in allocation protocols of donor (DN) organs, we sought to evaluate the impact of distance (DIS) from DN hospital on survival in heart transplant recipients (HTXR) Methods: We evaluated UNOS registry for all adult HTXR from 1990 to 2014 and their adult donors. Recipients with RVAD, BiVAD or TAH were excluded. Three different time periods (1990s, 2000s, and 2010 to June 2014) were compared to assess donor distance (DD) and ischemic time (IT) in hours (hrs) on survival. DD was stratified into categories based on distance in miles (M): 1,000 M. IT was stratified as: within 2 hrs, 2-4 hrs, and > 4 hrs. Chi-square analyses assessed association of DD with IT and by time period. Multivariable Cox proportional hazard regression assessed mortality with DIS and IT across time periods, adjusting for age, gender, and race.
8( 9)
Performing Coronary Angiography in High Risk Cardiac Donors Does Not Affect Renal Function in Kidney Recipients M. Lesouhaitier ,1 C. Legeai,2 E. Savoye,2 C. Cantrelle,2 I. Pipien,2 M. Macher,2 C. Vigneau,1 R. Dorent.2 1CHU Rennes, Rennes, France; 2Agence de la Biomédecine, Saint-Denis, France.
Donor Heart Diastolic Dysfunction: Do You Take This Heart for Transplantation? F. Liou , M. Kittleson, J. Patel, T. Aintablian, T. Kao, E. Kransdorf, D. Geft, D.H. Chang, L. Czer, D. Ramzy, J.A. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA.
Purpose: Coronary angiography (CA) is the gold standard for evaluation of coronary artery disease in potential multiorgan donors. The use of iodinated contrast medium has been associated with contrast-induced acute kidney injury and consequently could lead to delayed graft function (DGF) in kidney recipients. This study was designed to determine whether performing CA in donors affects early graft function in kidney recipients. Methods: From March 2012 to June 2014, all patients in France who received a kidney from a 45-70 year-old donor, susceptible to undergo CA, without contraindication for cardiac procurement and with at least one cardiovascular risk factor, were included. Kidney recipients of pre-emptive or multiorgan transplant, or who died within the first eight days post-transplant were excluded. A multivariate conditional logistic regression model stratified on the procurement hospital was developed to assess the association of donor CA with DGF by taking into account the center effect. Results: 892 kidneys from 483 donors were transplanted. DGF was reported in 45.6% of the 438 kidney recipients grafted with a kidney from the 257 donors without CA and in 38.9% of the 375 kidney recipients who received a kidney from the 217 donors with CA. Multivariate analysis showed that CA did not influence the risk of DGF (Table 1). CA did not increase the risk of primary non-function, the duration of DGF or of post-transplant hospital stay and did not affect graft function at one year (Table 2). Conclusion: These findings indicate that evaluation of potential multi-organ donors with CA does not affect early kidney graft outcomes.
Purpose: Donor heart selection for heart transplantation (HTx) is extremely variable. Donor hearts may have marginal features which have not been well characterized for post-HTx outcomes. We sought to determine if diastolic dysfunction (DD) in donor hearts is a risk factor for poor post-HTx outcome. Methods: Between 2007-2013, we assessed 381 pre-HTx donor hearts for DD, defined by Mitral Valve (MV) E/A ratio < 1. We identified 110 with available E/A measurements. Donors were divided into those with DD (n= 40) and those without, (MV E/A ≥ 1) (n= 70). All donor hearts had LVEF≥ 55%. Risk factors assessed by multivariate analysis included: DD, recipient age, donor age, status 1A at HTx, cytomegalovirus mismatch, pretransplant CAD, cold ischemic time > 4hr, creatinine > 1.5, pre-HTx hypertension, pre-HTx diabetes. Other endpoints assessed included 3-yr survival, freedom from cardiac allograft vasculopathy (stenosis ≥ 30%), freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE: Myocardial infarction, new CHF, angioplasty/stents, pacemaker insertion, stroke), 1-yr freedom from left ventricular dysfunction (LVEF ≤ 40%) and any-treated rejection. Results: By multivariate analysis, donor DD was not an independent predictor for 3-yr survival (P= 0.983, HR= 1.013, 95% CI [0.322,3.186]). Pts with donor DD had comparable 3-yr survival, freedom from CAV, and freedom from NF-MACE compared to those in the normal donor diastolic function group. 1-yr freedom from LV dysfunction and any-treated rejection were also comparable between the two groups. Of the pts with donor DD, 88.9% no longer had DD at 1-yr post-HTx. Conclusion: The use of donor hearts with DD does not predispose HTx pts to worse outcome.
Endpoints 3-Year Survival 3-Year Freedom from CAV 3-Year Freedom from NF-MACE 1-Year Freedom from LV Dysfunction 1-Year Freedom from Any-Treated Rejection
Normal Donor Diastolic Function (n= 70)
Donor Diastolic Dysfunction (n= 40)
Log-Rank P-Value
85.7% 80.7%
77.5% 81.4%
0.214 0.861
85.7%
90.2%
0.470
90.3%
96.2%
0.286
88.9%
88.4%
0.818
9( 0)
Does Distance from Donor Hospital Impact Survival in Heart Transplant Recipients? Y. Ravi ,1 E.M. Stock,2 S.K. Lella,3 J.V. Balasubramaniyan,4 S. Emani,5 C.B. Sai-Sudhakar.1 1Cardiac Surgery, Scott & White, Texas A&M, Temple, TX; 2Center for Applied Health Research, US Department of Veteran Affairs, Perry Point, MD; 3Texas A&M Health Science Centre College of Medicine, Temple, TX; 4Cardiology, Sri Ramachandra University, Chennai, India; 5Internal Medicine, The Ohio State University, Columbus, OH. Purpose: With current changes in allocation protocols of donor (DN) organs, we sought to evaluate the impact of distance (DIS) from DN hospital on survival in heart transplant recipients (HTXR) Methods: We evaluated UNOS registry for all adult HTXR from 1990 to 2014 and their adult donors. Recipients with RVAD, BiVAD or TAH were excluded. Three different time periods (1990s, 2000s, and 2010 to June 2014) were compared to assess donor distance (DD) and ischemic time (IT) in hours (hrs) on survival. DD was stratified into categories based on distance in miles (M): 1,000 M. IT was stratified as: within 2 hrs, 2-4 hrs, and > 4 hrs. Chi-square analyses assessed association of DD with IT and by time period. Multivariable Cox proportional hazard regression assessed mortality with DIS and IT across time periods, adjusting for age, gender, and race.