Are non-brain stem-dead cardiac donors acceptable donors?


Luckraz, H; Charman, SC; Parameshwar, J; Tsui, SS; Dunning, J; Wallwork, J; Large, SR; (2004) Are non-brain stem-dead cardiac donors acceptable donors? The Journal of heart and lung transplantation, 23 (3). pp. 330-3. ISSN 1053-2498 DOI: https://doi.org/10.1016/S1053-2498(02)01186-5

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Abstract

BACKGROUND: The deleterious effects of brainstem death (BSD) on donor cardiac function and endothelial integrity have been documented previously. Domino cardiac donation (heart of a heart-lung recipient transplanted into another recipient) is a way to avoid the effects of brainstem death and may confer both short- and long-term benefits to allograft recipients. METHODS: This study evaluates short- and long-term outcome in heart recipients of BSD donors (cadaveric) as compared with domino hearts explanted from patients who underwent heart-lung transplantation. RESULTS: Patients having undergone cardiac transplantation between April 1989 and August 2001 at Papworth Hospital were included (n = 571). Domino donor hearts were used in 81 (14%) of these cases. The pre-operative transpulmonary gradient was not significantly different between the two groups (p = 0.7). There was no significant difference in 30-day mortality (4.9% for domino vs 8.6% for BSD, p = 0.38) or in actuarial survival (p = 0.72). Ischemic time was significantly longer in the BSD group (p < 0.001). Acute rejection and infection episodes were not significantly different (p = 0.24 vs: 0.08). Relative to the BSD group, the risk (95% confidence interval) of acute rejection in the domino group was 0.89 (0.73 to 1.08). Similarly, the relative risk of infection was 0.78 (0.59 to 1.03). The 5-year actuarial survival rates (95% confidence interval) were 78% (69% to 87%) and 69% (65% to 73%) in the domino and BSD groups respectively. Angiography data at 2 years were available in 50 (62%) and 254 (52%) patients in the domino and BSD groups, respectively. The rates for 2-year freedom from cardiac allograft vasculopathy (CAV) were 96% (91% to 100%) and 93% (90% to 96%), respectively. CONCLUSION: Despite the lack of endothelial cell activation after brainstem death and a shorter ischemic time, the performance of domino donor hearts was similar to that of BSD donor hearts. This may indicate a similar pathology (i.e., endothelial cell activation) in the domino donors.

Item Type: Article
Keywords: Actuarial Analysis, Adult, *Brain Death, *Brain Stem, Cadaver, Case-Control Studies, Endothelium, Vascular/pathology, Female, Graft Rejection/epidemiology, *Heart Transplantation/methods, Heart-Lung Transplantation, Humans, Living Donors, Male, Middle Aged, Time Factors, *Tissue Donors, Treatment Outcome, Actuarial Analysis, Adult, Brain Death, Brain Stem, Cadaver, Case-Control Studies, Endothelium, Vascular, pathology, Female, Graft Rejection, epidemiology, Heart Transplantation, methods, Heart-Lung Transplantation, Humans, Living Donors, Male, Middle Aged, Time Factors, Tissue Donors, Treatment Outcome
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 15019643
Web of Science ID: 220155700010
URI: http://researchonline.lshtm.ac.uk/id/eprint/3006

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