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

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.