Impact of Donor Coronary Artery Disease on Recipient Outcomes in Heart Transplantation

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Aakash Shah, Justin Robinson, Corbin E. Goerlich, Chetan Pasrija, Bartley P. Griffith
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Abstract

Background. Efforts to expand the heart donor pool have included the use of extended criteria donors (e.g., advanced age or comorbid conditions). Another potential avenue is donor hearts with pre-existing coronary artery disease (CAD). Methods. A retrospective cohort study was performed using the Organ Procurement and Transplantation Network database between 10/1/1987 and 12/3/2020. Postoperative complications, graft failure, and survival were examined between recipients of donor hearts with abnormal (CAD donor) versus normal (non-CAD donor) coronary angiogram. Analysis was performed in unmatched cohorts as well as after propensity score matching. Results. A total of 12,230 heart transplant recipients were identified, of which 940 (7.6%) had an abnormal donor coronary angiogram. There were no differences between CAD and non-CAD donor groups in acute rejection, stroke, or dialysis prior to discharge or treatment for rejection <1 year. However, the CAD donor group had a greater pacemaker incidence (5.2% vs. 3.6%, P = 0.02). After matching, 785 patients were in each group and there were no differences in perioperative outcomes or treatment for rejection <1 year. There was no difference in 10-year freedom from graft failure (53.1% vs. 54.6%, log rank = 1.03, and P = 0.31) or cumulative survival (54.7% vs. 55.8%, log rank = 0.63, and P = 0.43) between the matched CAD and non-CAD donor groups. Conclusion. The presence of CAD may not be a contraindication to transplantation. Carefully selected donor hearts with CAD may have equivalent postoperative and long-term outcomes to donor hearts without CAD. Further study in this area may expand the pool of donors.

Abstract Image

供体冠状动脉疾病对心脏移植受体预后的影响
背景。扩大心脏供体库的努力包括使用扩展标准供体(如高龄或合并症)。另一个潜在的途径是捐献预先存在冠状动脉疾病(CAD)的心脏。方法。利用器官获取和移植网络数据库对 1987 年 10 月 1 日至 2020 年 3 月 12 日期间的情况进行了回顾性队列研究。对冠状动脉造影异常(CAD 供体)与冠状动脉造影正常(非 CAD 供体)的供体心脏受体之间的术后并发症、移植失败和存活率进行了研究。分析在非匹配队列和倾向得分匹配后进行。结果。共确定了 12,230 名心脏移植受者,其中 940 人(7.6%)的供体冠状动脉造影异常。在急性排斥反应、中风、出院前透析或排斥反应治疗<1年方面,CAD和非CAD供体组之间没有差异。不过,CAD供体组的起搏器安装率更高(5.2% vs. 3.6%,P = 0.02)。配对后,两组各有785名患者,围手术期结果或排斥反应治疗<1年无差异。匹配的 CAD 供体组和非 CAD 供体组在 10 年免于移植失败(53.1% 对 54.6%,对数秩 = 1.03,P = 0.31)或累积存活率(54.7% 对 55.8%,对数秩 = 0.63,P = 0.43)方面没有差异。结论存在 CAD 可能不是移植的禁忌症。精心挑选的有 CAD 的供体心脏可能与无 CAD 的供体心脏具有相同的术后和长期预后。这方面的进一步研究可能会扩大供体库。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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