Heart transplantation outcomes from cardiac arrest–resuscitated donors

https://doi.org/10.1016/j.healun.2013.08.002Get rights and content

Background

The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors (CPR+) to those who received hearts from donors who did not require cardiopulmonary resuscitation (CPR).

Methods

This investigation was a retrospective analysis of UNOS adult heart transplantation donor and recipient data from May 1994 through July 2012. Discrete variables were compared using the chi-square test. Continuous variables were compared using the t-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon’s test.

Results

Of the 29,242 adult heart transplantations performed in USA during the study period, 1,396 patients (4.7%) received hearts from CPR+ donors. The patients in the CPR+ group were younger (25.5 ± 15 years vs 28.5 ± 14 years; p < 0.0001) and more likely to be female (31% vs 27%; p = 0.001). Mean duration of CPR in these donors was 20 minutes. UNOS listing status at the time of transplantation was Status 1A for 54.3% of those in the CPR+ group and 46.9% in the CPR group (p < 0.0001). More recipients were hospitalized and were in the intensive care unit at transplantation in the CPR+ group (56% vs 51%; p = 0.0008). Recipient survival at 30 days, 1 year and 5 years was 95.2%, 88.2% and 72.9% in CPR+ group, and 94.7%, 87.7% and 74.4% in the CPR group, respectively. Similarly, graft survival at 30 days, 1 year and 5 years was 94.7%, 87.6% and 71.9% in the CPR+ donor hearts, and 94.4%, 87.3% and 73.2% in the CPR donor hearts, respectively.

Conclusions

This large, multicenter adult heart transplant database from across the USA did not show inferior outcomes in recipients of heart transplantation from selected CPR+ donors. Recipient and graft survival were similar over 5 years of follow-up.

Section snippets

Methods

The United Network for Organ Sharing (UNOS) collects data on heart donors and recipients from all transplant centers across the USA. Since May 1994, CPR status of all potential donors was included in the set of donor variables and we dated our data query to that date. From May 1994 to July 2012, there were 29,242 heart transplantations performed in the USA. All data on donor and recipient variables were collected and analyzed by dividing them into 2 groups: a CPR+ donor group and a CPR donor

Results

Of the 29,242 adult heart transplantations performed in the USA during the study period, 1,396 patients (4.7%) received hearts from CPR+ donors. Donor characteristics are summarized in Table 1. Mean age of donors in the CPR+ group was 25.5 ± 15 years vs 28.5 ± 14 years in the CPR group (p < 0.0001). There were significantly more female donors in the CPR+ group. Anoxia as a cause of death was significantly more common in the CPR+ group, whereas stroke was more common in the CPR group. All

Discussion

It is important to find every opportunity to optimize utilization of donor organs in the face of a steady rise in the number of patients waiting for heart transplantation. Cardiopulmonary arrest and resuscitated organ donors represents one of the underutilized groups.8 Our study has shown that accepting a heart from CPR+ donor did not result in poor outcomes for the recipient at 30-day, 1-year and 5-year intervals. In addition, duration of CPR had no adverse impact on recipient survival, both

Disclosure statement

The authors have no conflicts of interest to disclose.

We thank UNOS for providing us with the data for this project. We also thank Professor Anthony Minisi, MD, for advice and editorial assistance in revising the manuscript.

References (20)

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