Save a trip: Clinical outcomes of cardiac allografts recovered by local surgeons compared to recipient center surgeons.

Background

Local surgeon recovery of donor livers and kidneys is common and well-studied. This practice is rare and poorly studied in cardiac transplantation. We examined clinical outcomes of cardiac allografts recovered by local surgeons vs. recipient institution surgeons.

Methods

A retrospective review of all recoveries of adult cardiac allografts from brain dead donors for a single academic transplant center between 1/2020 and 12/2021 was performed. Donor and recipient baseline characteristics, distance traveled and ischemic time, and recipient outcomes were collected. Primary graft dysfunction (PGD) was determined based on 2014 ISHLT guidelines.

Results

218 recovery attempts were included, 25 conducted by local surgeons. Donor demographics between the two groups were similar, with a mean age of 31.5±10 years. There was a non-significant trend towards higher acceptance rates by local surgeons compared to recipient center surgeons (96% vs 82.9%, p=0.139). Ischemic times (208±28 vs 176±61 min p=0.003) and travel distances (788 vs 615 miles, p=0.011) were longer in the local recovery group. There was no difference in severe PGD (4.2% vs 7.5%, p=1.0), moderate/severe PGD (12.5% vs 14.4%, p=0.22) or 30-day survival (95.8% vs 95%, p=0.218) between the local surgeon and recipient center recovered allografts.

Conclusion

Cardiac allografts recovered by a local surgeon team are high quality with similar rates of organ acceptance, PGD, and 30-day survival. This provides evidence that leveraging the expertise of the local surgical team is a safe and effective method for decreasing travel risks, financial expenditure, and opportunity cost associated with cardiac allograft recovery.