TY - JOUR
T1 - Impact of Deceased Donor Management on Donor Heart Use and Recipient Graft Survival
AU - Swanson, Elizabeth A.
AU - Adams, Tony
AU - Patel, Madhukar S.
AU - De La Cruz, Salvador
AU - Hutchens, Michael
AU - Khush, Kiran
AU - Sally, Mitchell B.
AU - Niemann, Claus U.
AU - Groat, Tahnee
AU - Malinoski, Darren J.
N1 - Funding Information:
Support: This work was supported by the Health Resources and Services Administration (R38 OT22183). Dr Swanson received support from the National Institute of Diabetes and Digestive and Kidney Diseases (F30 DK114980), Dr Hutchens received support from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development (VA Merit Award I01BX004288), and Dr Khush and Dr Malinoski received support from the National Heart, Lung, and Blood Institute (1R01HL12530301). Dr Malinoski's institution received an NIH subaward from Stanford (11566320). Disclosure Information: This work was supported by grant funding from Arnold Ventures, LLC.
Funding Information:
Disclosure Information: This work was supported by grant funding from Arnold Ventures, LLC.
Funding Information:
Support: This work was supported by the Health Resources and Services Administration ( R38 OT22183 ). Dr Swanson received support from the National Institute of Diabetes and Digestive and Kidney Diseases ( F30 DK114980 ), Dr Hutchens received support from the Department of Veterans Affairs , Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development (VA Merit Award I01BX004288 ), and Dr Khush and Dr Malinoski received support from the National Heart, Lung, and Blood Institute ( 1R01HL12530301 ). Dr Malinoski’s institution received an NIH subaward from Stanford ( 11566320 ).
Publisher Copyright:
© 2020 American College of Surgeons
PY - 2020/9
Y1 - 2020/9
N2 - Background: Current risk-adjusted models used to predict donor heart use and cardiac graft survival from organ donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between donor management and transplantation outcomes. Study Design: We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during donor management. The primary outcomes measures were donor heart use and cardiac graft survival. Results: From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included donor age (OR 0.94), BMI > 30 kg/m2 (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h). Conclusions: Modifiable critical care parameters and treatments predict donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.
AB - Background: Current risk-adjusted models used to predict donor heart use and cardiac graft survival from organ donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between donor management and transplantation outcomes. Study Design: We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during donor management. The primary outcomes measures were donor heart use and cardiac graft survival. Results: From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included donor age (OR 0.94), BMI > 30 kg/m2 (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h). Conclusions: Modifiable critical care parameters and treatments predict donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.
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U2 - 10.1016/j.jamcollsurg.2020.05.025
DO - 10.1016/j.jamcollsurg.2020.05.025
M3 - Article
C2 - 32562768
AN - SCOPUS:85088792877
VL - 231
SP - 351-360.e5
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 3
ER -