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Tolerance to Perioperative Cold Ischemia in Donor Myocardium: Gender Differences
Abstracts S71 p = 0.0495). Compared to a propensity-matched SL cohort, the relative HT rate among ML patients was 4.33 (95% CI 3.81-4.92, p < 0.0001). There were no post-HT survival differences. Conclusion: The decision of HT candidates to pursue multiple listing is a rational response to organ shortage. But the ML allowance advantages patients with the means to utilize it rather than those with greatest medical need. The ML policy should be reconsidered.
1( 70) Longer Waiting Time Increases Mortality in Heart Transplantation: An Instrumental Variable Analysis K.K. Khush ,1 J.G. Zaroff,2 J. Nguyen,3 B.A. Goldstein.4 1Cardiovascular Medicine, Stanford University, Stanford, CA; 2Division of Research, Kaiser Northern California, Oakland, CA; 3California Transplant Donor Network, Oakland, CA; 4Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. Purpose: Over the past decade there has been a decline in use of available donor hearts for transplantation in the United States reflecting, in part, adoption of conservative practices for donor heart acceptance. This, combined with a national donor organ shortage, has resulted in increasingly long waiting times for heart transplantation. We studied the relationship between heart transplant waiting time and mortality to determine whether conservative donor heart acceptance practices may have the unintended consequence of increasing mortality among patients awaiting transplantation. Methods: We studied a cohort of 28,283 adults registered on the United Network for Organ Sharing (UNOS) heart transplant waiting list between 2000 and 2010 to examine the relationship between time spent on the waiting list and the composite outcome of removal from the waiting list for worsening medical condition or death, or graft failure or death within 30 days of transplantation. Transplant candidate blood type was used as an instrumental variable to mitigate the effect of unmeasured confounding. Results: Our results suggest an association between waiting time and waitlist mortality: doubling the waiting time increased the odds of mortality by 46% (OR 1.46 [1.33-1.63]), with the effect differing by waitlist priority status (1A, 1B, or 2). However, waiting time had no impact on graft failure or death after transplantation (OR= 1.09 [0.97, 1.23]). Conclusion: Our findings suggest a relationship between time spent on the waiting list and mortality, thereby supporting research aimed at defining adequate donor heart quality and acceptance standards for heart transplantation. 1( 71) Adult Heart Transplant Survival Is Not Affected By Use of Centers of Disease Control High-Risk Donor Hearts G.H. Oliveira , S. Kumar, S. Al-Kindi, M. Ige, C. ElAmm, M. Ginwalla, S. Deo, S.J. Park. University Hospitals Case Medical Center, Cleveland, OH. Purpose: The growing scarcity of organs available for heart transplantation has spurred use of left ventricular assist devices as destination therapy for suboptimal transplant candidates. A large number of organs are turned down because they belong to CDC high-risk donors and could potentially be utilized in suboptimal candidates. We sought to investigate whether use of cardiac allografts from CDC high-risk donors is associated with worse post-transplant survival. Methods: We examined the UNOS database for patients (age≥ 18) who received heart transplantation between 1994 and 2013 and have known donor graft status (high risk versus non-high risk). CDC high risk donor is defined as men who have sex with men within 5 years, non-medical injections within 5 years, history of hemophilia or clotting disorder, history of engaging in sex for money, history of sex with a high-risk group, known or suspected exposure to HIV and prison inmates. Results: Of 90,500 patients who received heart transplants, we identified 17,823 patients who met the inclusion criteria. Majority of recipients were Caucasian (69.3%), males (75.2%), with a mean age at transplant of 52.2 (+ 12.7) years. 1726 (9.7%) received cardiac allografts from HRDs. The utilization of HRDs has increased from 0 in 1994 to 215 in 2013. The 1-, 3-, and 5- year survival was 89%, 81% and 73% in HRD and 88%, 81%, and 75% in non-HRD (log rank p= 0.44). Conclusion: Post-transplant survival does not appear to be affected by HRD cardiac allograft use. Although increasing slowly, HRD cardiac allografts are underutilized and may provide a better alternative to left ventricular devices as destination therapy in suboptimal transplant candidates.
1( 72) Tolerance to Perioperative Cold Ischemia in Donor Myocardium: Gender Differences O. Szarszoi ,1 M. Smetana,1 L. Hoskova,2 I. Netuka,1 J. Besik,1 J. Maly,1 J. Maluskova,3 A. Lodererova,3 J. Pirk.1 1Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 2Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 3Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Purpose: There is no doubt that a lot of structural and metabolic functions of cardiovascular apparatus are essentially affected by gender. Experimental studies on animals have shown that female hearts are more resistant to ischemia and other pathologic processes then male hearts. The aim of our study was to find out the differences in the tolerance of human female and male grafts to the perioperative cold ischemia. Methods: The prospective study involved 81 consecutive patients who underwent orthotopic heart transplantation at our institution from September 2010 to December 2012. Patients were divided into two groups according to donor gender: male allograft (n = 49), female allograft (n = 32). Two types of myocardial cell death were analyzed. High-sensitive cardiac troponin T (hs troponin T) as a marker of necrosis was measured before heart harvesting, before recipient’s sternotomy, 2h after transplantation, first postoperative day and one week after surgery. Apoptosis induced by heart ischemia was evaluated in biopsy specimens using antiapoptotic protein bcl-2, proapoptotic protein caspase 3 and TUNEL assay. Biopsies were performed before graft harvesting, 20 min after releasing of crossclamp and one week after transplantation. Results: We did not observe differences between groups in the level of hs troponin T before transplantation, nevertheless 2h after surgery hs troponin T I was significantly lower in patients with female allograft (2886 ± 263.5 vs. 3906 ± 372.6); first postoperative day and week after transplantation we did not see differences between groups. Although both genders showed significantly increased number of TUNEL positive myocytes in response to perioperative cold ischemia one week after transplantation (male: 19.2 ± 1.6 vs. 4.4 ± 0.6; female 20.7 ± 1.9 vs. 8.7 ± 1.9) there were no differences between both groups. Moreover, we did not see differences in the expression of bcl-2 and caspase 3 in the male and female grafts. Conclusion: Our results support hypothesis that the female myocardium is more resistant to ischemia. The role of apoptosis in the human hearts after transplantation needs further investigation. Study was supported by Grant IGA MZ NT/11269 - 5. 1( 73) Successful Orthotropic Heart Transplantation Using Donors With Left Ventricular Systolic Dysfunction: Evidence for Brain Death-Induced Takotsubo Cardiomyopathy S.D. Rao , A. Watson, P. Lo, A. Jabbour, C.S. Hayward, A.M. Keogh, E. Kotlyar, E. Granger, P. Jansz, P. Spratt, K. Dhital, P.S.
1( 70) Longer Waiting Time Increases Mortality in Heart Transplantation: An Instrumental Variable Analysis K.K. Khush ,1 J.G. Zaroff,2 J. Nguyen,3 B.A. Goldstein.4 1Cardiovascular Medicine, Stanford University, Stanford, CA; 2Division of Research, Kaiser Northern California, Oakland, CA; 3California Transplant Donor Network, Oakland, CA; 4Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. Purpose: Over the past decade there has been a decline in use of available donor hearts for transplantation in the United States reflecting, in part, adoption of conservative practices for donor heart acceptance. This, combined with a national donor organ shortage, has resulted in increasingly long waiting times for heart transplantation. We studied the relationship between heart transplant waiting time and mortality to determine whether conservative donor heart acceptance practices may have the unintended consequence of increasing mortality among patients awaiting transplantation. Methods: We studied a cohort of 28,283 adults registered on the United Network for Organ Sharing (UNOS) heart transplant waiting list between 2000 and 2010 to examine the relationship between time spent on the waiting list and the composite outcome of removal from the waiting list for worsening medical condition or death, or graft failure or death within 30 days of transplantation. Transplant candidate blood type was used as an instrumental variable to mitigate the effect of unmeasured confounding. Results: Our results suggest an association between waiting time and waitlist mortality: doubling the waiting time increased the odds of mortality by 46% (OR 1.46 [1.33-1.63]), with the effect differing by waitlist priority status (1A, 1B, or 2). However, waiting time had no impact on graft failure or death after transplantation (OR= 1.09 [0.97, 1.23]). Conclusion: Our findings suggest a relationship between time spent on the waiting list and mortality, thereby supporting research aimed at defining adequate donor heart quality and acceptance standards for heart transplantation. 1( 71) Adult Heart Transplant Survival Is Not Affected By Use of Centers of Disease Control High-Risk Donor Hearts G.H. Oliveira , S. Kumar, S. Al-Kindi, M. Ige, C. ElAmm, M. Ginwalla, S. Deo, S.J. Park. University Hospitals Case Medical Center, Cleveland, OH. Purpose: The growing scarcity of organs available for heart transplantation has spurred use of left ventricular assist devices as destination therapy for suboptimal transplant candidates. A large number of organs are turned down because they belong to CDC high-risk donors and could potentially be utilized in suboptimal candidates. We sought to investigate whether use of cardiac allografts from CDC high-risk donors is associated with worse post-transplant survival. Methods: We examined the UNOS database for patients (age≥ 18) who received heart transplantation between 1994 and 2013 and have known donor graft status (high risk versus non-high risk). CDC high risk donor is defined as men who have sex with men within 5 years, non-medical injections within 5 years, history of hemophilia or clotting disorder, history of engaging in sex for money, history of sex with a high-risk group, known or suspected exposure to HIV and prison inmates. Results: Of 90,500 patients who received heart transplants, we identified 17,823 patients who met the inclusion criteria. Majority of recipients were Caucasian (69.3%), males (75.2%), with a mean age at transplant of 52.2 (+ 12.7) years. 1726 (9.7%) received cardiac allografts from HRDs. The utilization of HRDs has increased from 0 in 1994 to 215 in 2013. The 1-, 3-, and 5- year survival was 89%, 81% and 73% in HRD and 88%, 81%, and 75% in non-HRD (log rank p= 0.44). Conclusion: Post-transplant survival does not appear to be affected by HRD cardiac allograft use. Although increasing slowly, HRD cardiac allografts are underutilized and may provide a better alternative to left ventricular devices as destination therapy in suboptimal transplant candidates.
1( 72) Tolerance to Perioperative Cold Ischemia in Donor Myocardium: Gender Differences O. Szarszoi ,1 M. Smetana,1 L. Hoskova,2 I. Netuka,1 J. Besik,1 J. Maly,1 J. Maluskova,3 A. Lodererova,3 J. Pirk.1 1Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 2Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 3Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Purpose: There is no doubt that a lot of structural and metabolic functions of cardiovascular apparatus are essentially affected by gender. Experimental studies on animals have shown that female hearts are more resistant to ischemia and other pathologic processes then male hearts. The aim of our study was to find out the differences in the tolerance of human female and male grafts to the perioperative cold ischemia. Methods: The prospective study involved 81 consecutive patients who underwent orthotopic heart transplantation at our institution from September 2010 to December 2012. Patients were divided into two groups according to donor gender: male allograft (n = 49), female allograft (n = 32). Two types of myocardial cell death were analyzed. High-sensitive cardiac troponin T (hs troponin T) as a marker of necrosis was measured before heart harvesting, before recipient’s sternotomy, 2h after transplantation, first postoperative day and one week after surgery. Apoptosis induced by heart ischemia was evaluated in biopsy specimens using antiapoptotic protein bcl-2, proapoptotic protein caspase 3 and TUNEL assay. Biopsies were performed before graft harvesting, 20 min after releasing of crossclamp and one week after transplantation. Results: We did not observe differences between groups in the level of hs troponin T before transplantation, nevertheless 2h after surgery hs troponin T I was significantly lower in patients with female allograft (2886 ± 263.5 vs. 3906 ± 372.6); first postoperative day and week after transplantation we did not see differences between groups. Although both genders showed significantly increased number of TUNEL positive myocytes in response to perioperative cold ischemia one week after transplantation (male: 19.2 ± 1.6 vs. 4.4 ± 0.6; female 20.7 ± 1.9 vs. 8.7 ± 1.9) there were no differences between both groups. Moreover, we did not see differences in the expression of bcl-2 and caspase 3 in the male and female grafts. Conclusion: Our results support hypothesis that the female myocardium is more resistant to ischemia. The role of apoptosis in the human hearts after transplantation needs further investigation. Study was supported by Grant IGA MZ NT/11269 - 5. 1( 73) Successful Orthotropic Heart Transplantation Using Donors With Left Ventricular Systolic Dysfunction: Evidence for Brain Death-Induced Takotsubo Cardiomyopathy S.D. Rao , A. Watson, P. Lo, A. Jabbour, C.S. Hayward, A.M. Keogh, E. Kotlyar, E. Granger, P. Jansz, P. Spratt, K. Dhital, P.S.