BACKGROUND Previous studies have demonstrated that carefully selected donor hearts (DHs) with poor left ventricular ejection fraction (EF) may be transplanted with long-term survival equivalent to hearts with normal function. The purpose of this study is to facilitate their selection. METHODS Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Regression models were developed to estimate hazard ratios with 95% confidence intervals of post-transplant 1-year mortality and failure of EF to recover at 1 year for DHs with EF ≥50%, EF 40%-49.9%, and EF 30%-30.9%. RESULTS During the study period, 31,979 DHs were transplanted. Compared with DHs with left ventricular ejection fraction ≥50%, DHs with reduced EF were younger and had slightly lower body mass index. There were no differences in the mechanism of death between groups and no differences in recipient characteristics, except for a higher incidence of African American recipients of hearts with an EF of 40%-49.9%. Of the variables analyzed, only a 1-hour increase in ischemia time had different hazard ratios for 1-year mortality between groups, with increasing hazard as EF diminished. It was also the only variable that predicted failure of recovery of normal EF and that was in the lowest EF group. CONCLUSIONS The impact of DH traits associated with adverse outcomes after heart transplantation that we studied are similar between DHs with EF <50% and those with EF ≥50%. However, limiting ischemic time may be even more important for DHs with diminished left ventricular function, particularly at the low end of the EF spectrum.

中文翻译：

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对左心室功能减弱的供体心脏缺血间隔的敏感性增加。

背景 先前的研究表明，精心挑选的左心室射血分数 (EF) 差的供体心脏 (DH) 可以移植，其长期存活率与功能正常的心脏相当。这项研究的目的是促进他们的选择。方法 使用器官共享联合网络数据库，我们回顾了 2000 年 1 月至 2016 年 3 月期间的所有成人心脏移植。开发回归模型以估计移植后 1 年死亡率和 EF 恢复失败的 95% 置信区间的风险比对于 EF ≥50%、EF 40%-49.9% 和 EF 30%-30.9% 的 DH，在 1 年时。结果 在研究期间，移植了 31,979 名 DH。与左心室射血分数≥50%的DHs相比，EF降低的DHs更年轻，体重指数略低。除了非裔美国人心脏接受者的 EF 为 40%-49.9% 的发生率较高外，各组之间的死亡机制没有差异，接受者特征也没有差异。在分析的变量中，缺血时间仅增加 1 小时，组间 1 年死亡率的风险比不同，随着 EF 降低，风险增加。它也是预测正常 EF 恢复失败的唯一变量，并且是最低 EF 组。结论 我们研究的与心脏移植后不良结果相关的 DH 特征的影响在 EF <50% 的 DH 和 EF ≥50% 的 DH 之间是相似的。然而，限制缺血时间对于左心室功能减弱的 DHs 可能更为重要，尤其是在 EF 谱的低端。