Heart transplant survival and the use of donors with intracranial bleeding: United Network for Organ Sharing Registry propensity-score matched analysis.

Objective: The transplantation of hearts from donors who experienced intracranial bleeding (ICB) has been associated with inferior long-term survival in both single-center analyses and, more recently, with the United Network for Ogan Sharing Registry. The purpose of this study was to further explore this relationship through propensity score matching in recipients receiving donor hearts from ICB and non-ICB donors in a large national registry.

Methods: We performed a retrospective cohort analysis of the United Network for Organ Sharing Registry Organ Procurement and Transplantation Network between 2006 and 2018 for adult candidates wait-listed for isolated heart transplantation. Recipients were stratified into 2 groups: ICB and non-ICB donors. Propensity score matching was performed to estimate causal effects by using observational data. Kaplan-Meier analysis was used to estimate survival posttransplant. Cox proportional hazards modeling was used to evaluate the independent effect of ICB as a cause of death.

Results: A total of 25,315 candidates met inclusion criteria. ICB heart donors (n = 5529) were older (median age, 42 vs 27 years; P < .001), less likely men (54.5% vs 75.2%; P < .001), and more often had a history of smoking (20.1% vs 11.7%; P < .001), and hypertension (34.2% vs 9.5%; P < .001). Before matching there was a significant difference in long-term posttransplant survival; for example, the non-ICB (60.7% [interquartile range, 59.5%-61.9%] vs 56.8% (interquartile range, 54.7%-59.0%]; P < .0001). However, when analyzing the propensity-score matched groups for outcomes, no difference was found between the cohorts both in terms of long-term survival as well as in rates of rejection.

Conclusions: In the largest propensity score matching analysis of heart transplants from donors who had experienced ICB, we found similar survival and rejection rates in heart transplant recipients.