Thorac Cardiovasc Surg 2022; 70(S 01): S1-S61
DOI: 10.1055/s-0042-1742859
Oral and Short Presentations
Monday, February 21
Heart and Lung Transplantation: Donor Situation and Outcome Optimization

Intracerebral Bleeding in Donors Is Associated with Worsened Outcome and Reduced Short- to Midterm Survival of Heart Transplant Recipients

D. Oehler
1   Department of Cardiology, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
M. B. Immohr
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
S. Erbel
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
H. Aubin
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
R. Bruno
1   Department of Cardiology, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
H. T. Holst
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
R. Westenfeld
1   Department of Cardiology, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
P. Horn
1   Department of Cardiology, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
I. Tudorache
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
P. Akhyari
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
A. Lichtenberg
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
,
U. Boeken
2   Department of Cardiac Surgery, Medical faculty, University Hospital of the Heinrich-Heine-University, Duesseldorf, Deutschland
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Background: The quality of the donor heart has a crucial effect on outcome after heart transplantation (HTx). Leading to brain dead in the end, the initial cause of death of the donor and its potential influences on organ quality are heterogenous. However, it is still controversial to which extent the donor cause of death is associated with outcome or survival post HTx.

Method: We included all patients undergoing HTx in our center between 09/2010 and 06/2021 (n = 217). Recipients were divided into five groups related to their donor cause of death: intracerebral bleeding (n = 95, 44%), traumatic brain injury (n = 54, 25%), hypoxic brain damage (n = 34, 16%), cerebrovascular (n = 15, 7%), or other cause (n = 20, 9%). Baseline characteristics, perioperative parameters, and survival were collected.

Results: Intracerebral bleeding in donors compared with traumatic brain injury is associated with higher probability of need for ECLS post HTx (35 vs. 19%, p = 0.04) and reduced survival up to 3 years post-HTx (year survival: 61 vs. 98%, p < 0.001). The effect is strongest for ICB, where survival is also significantly reduced when comparing to all other causes (year: 61 vs. 89%, p < 0.001; [Table 1]).

Table 1

Patient baseline characteristics, perioperative parameters, and survival after heart transplantation, grouped by donor cause of death

Gr 1 (n = 95)

Gr 2 (n = 54)

Gr 3 (n = 34)

Gr 4 (n = 15)

Gr 5 (n = 20)

p

ICB

Trauma

Hypoxic

Cerebrovascular

Other

1 vs. 2

1 vs. 3

1 vs. 4

2 vs. 3

2 vs. 4

3 vs. 4

Age (y)

55.7 ± 10.7

50.1 ± 12.2

57.9 ± 9.0

54.5 ± 10.7

58.3 ± 6.6

<0.05

ns

ns

<0.05

ns

ns

Sex (% male)

63

76

91

80

80

ns

<0.05

ns

ns

ns

ns

Dur surg. (min)

453.4 ± 124.5

419.3 ± 104.1

440.8 ± 122.6

416.0 ± 95.0

424,4 ± 107.7

ns

ns

ns

ns

ns

ns

ECLS po HTx (%)

35

19

33

20

25

<0.05

ns

ns

ns

ns

ns

Infection/Sepsis (%)

23

19

29

26.7

33

ns

ns

ns

ns

ns

ns

Survival 30 d (%)

84

100

97

93

95

<0.05

ns

ns

ns

ns

ns

Survival 90 d (%)

77

100

93

87

81

<0.001

ns

ns

ns

0,05

ns

Survival year (%)

61

98

86

79

72

<0.001

<0.05

ns

ns

<0.05

ns

Conclusion: In this retrospective analysis, donor cause of death is associated with differing outcome and survival after HTx.



Publication History

Article published online:
03 February 2022

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