Background

We evaluated post-heart transplant (HTx) outcomes after use of higher-risk donor hearts for candidates supported with pre-HTx mechanical circulatory support (MCS).

Methods

In this retrospective analysis of the national United Network for Organ Sharing registry, a total of 9,915 adult candidates on MCS underwent HTx from January 1, 2010 to March 31, 2019. Multi-organ, re-transplant, and congenital heart disease patients were excluded. Higher-risk donor organs met at least one of the following criteria: left ventricular ejection fraction <50%, donor to recipient predicted heart mass ratio <0.86, donor age >55 years, or ischemic time >4 hours. Primary outcome was 1 year post-transplant survival.

Results

Among HTx recipients, 3688 (37.2%) received higher-risk donor hearts. Candidates supported with pre-HTx extracorporeal membrane oxygenation or biventricular assist device (n = 374, 3.8%) who received higher-risk donor hearts had comparable 1 year survival (HR: 1.14, 95% CI: [0.67-1.93], p = 0.64) to recipients of standard-risk donor hearts, when adjusted for recipient age and sex. In candidates supported with intra-aortic balloon pump (n = 1391, 14.6%), transplantation of higher-risk donor hearts did not adversely affect 1 year survival (HR: 0.80, 95% CI: [0.52-1.22], p = 0.30). Patients on durable left ventricular assist devices (LVAD) who received higher-risk donor hearts had comparable 1 year survival to continued LVAD support on the waitlist, but mortality was increased compared to those who received standard-risk donor hearts (HR: 1.37, 95% CI: [1.11-1.70], p = 0.004).

Conclusions

Patients requiring pre-HTx temporary MCS who received higher-risk donor hearts had comparable 1 year post-transplant survival to those who received standard-risk donor hearts. Stable patients on durable LVADs may benefit from waiting for standard-risk donor hearts.

中文翻译：

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使用高风险供体心脏对移植前机械循环支持的候选人的影响

背景

我们评估了使用高风险供体心脏后心脏移植 (HTx) 的结果，用于支持 HTx 前机械循环支持 (MCS) 的候选人。

方法

在这项对全国器官共享联合网络登记处的回顾性分析中，从 2010 年 1 月 1 日至 2019 年 3 月 31 日，共有 9,915 名 MCS 成年候选人接受了 HTx。排除了多器官、再移植和先天性心脏病患者. 较高风险的供体器官至少满足以下标准之一：左心室射血分数<50%，供体与受体的预测心脏质量比<0.86，供体年龄>55岁，或缺血时间>4小时。主要结果是移植后 1 年的存活率。

结果

在 HTx 接受者中，3688 人（37.2%）接受了高风险的捐赠心脏。接受 HTx 前体外膜肺氧合或双心室辅助装置 ( n  = 374, 3.8%) 且接受高风险供体心脏的候选人有相当的 1 年生存率 (HR: 1.14, 95% CI: [0.67-1.93], p  = 0.64）对标准风险供体心脏的接受者，当调整接受者年龄和性别时。在使用主动脉内球囊泵 ( n = 1391, 14.6%)支持的候选人 中，高风险供体心脏的移植不会对 1 年生存率产生不利影响 (HR: 0.80, 95% CI: [0.52-1.22], p = 0.30）。接受高风险供体心脏的耐用左心室辅助装置 (LVAD) 患者的 1 年生存率与等待名单上持续 LVAD 支持的患者相比，但死亡率高于接受标准风险供体心脏的患者 (HR: 1.37, 95 % CI：[1.11-1.70]，p  = 0.004）。

结论

接受高风险供体心脏的需要 HTx 前临时 MCS 的患者在移植后 1 年的存活率与接受标准风险供体心脏的患者相当。使用耐用 LVAD 的稳定患者可能会受益于等待标准风险的供体心脏。