Search

Donors of death due to anoxic brain injury such as suicidal hanging are at risk for a severe catecholamine surge leading to an acute myocardial stress that can cause global tissue hypoxia as well as pulmonary edema and barotrauma, all of which may potentially adversely impact myocardial tissue. Concerns have been raised about potential higher rates of Primary Graft Dysfunction (PGD) in heart transplant recipients of such donors due to this acute myocardial stressor. We wanted to assess if this mechanism of donor death does carry an increased risk of PGD or other adverse outcomes in our single center experience. Between January 2014 and July 2019, 331 heart transplantations were performed at our center. Seventeen patients received a heart from donors after suicidal hanging, confirmed by review of the United Network for Organ Sharing UNet DonorNet database. Three out of 17 recipients (18%) from suicidal hanging donors experienced primary graft dysfunction (PGD) peri-operatively requiring extracorporeal membrane oxygenation (ECMO). In comparison, 29 out of 314 recipients (9%) from all other donors during this time period experienced PGD requiring peri-operative ECMO (p = 0.25). The 30-day and 1-year survival among recipients of grafts from suicidal hanging donors were 16/17 (94%) and 16/17 (94%), respectively. The one death during this period was due to complications from PGD (multi-system organ failure, ischemic limb with ECMO). Overall, in a large-volume, single-center experience, while there was a trend toward a higher incidence of PGD requiring ECMO, transplantation of a heart from a suicidal hanging donor was not associated with a higher 30-day and 1-year mortality. Thus, these results suggest that hearts from suicidal hanging donors may be appropriately considered for transplantations, with heightened awareness of a possible increased risk of PGD requiring ECMO. [ABSTRACT FROM AUTHOR]

AlloSure test is a non-invasive blood test designed to detect the presence of donor cell-free DNA in the recipients blood as a measure of the probability of rejection in heart transplant recipients. The result is displayed as a percent of donor-derived cell-free DNA (dd-cfDNA) in the totalcell-free DNA (cfDNA). Recommended threshold of 0.2% dd-cfDNA has been predictive of low likelihood of rejection. There is no data looking at its value and validation in multi-organ transplant. We aimed to study this area by reviewing our transplant database. All patients who received more than one solid organ transplant at our center and had AlloSure testing were included. Study outcomes included one year survival, rejection grade 2R or more, and hemodynamically significant graft dysfunction. There were (7) patients included in the study, average AlloSure score was 0.93% ±0.61% with an average AlloMap score of 33.8±2.14. Four patients (57.1%) had heart and kidney transplant, 3 patients (42.9%) had heart and liver transplantation. Average AlloSure score for heart/kidney transplant recipients was 0.52±0.17% with an average AlloMap score of 33.6±2.28. The while average AlloSure score for heart/liver transplant recipients was 1.21±0.55% mean AlloMap score of 33.93±2.32. None of our patients had graft dysfunction or biopsy-proven rejection >=2R. Survival rate was 100% for the first year in our patients AlloSure levels were higher in heart-liver vs. heart-kidney recipients, and in both cohorts higher than the 0.2% threshold recommended for heart transplant prediction of rejection, however did not predict rejection. In our cohort, while AlloMap scores were consistent in both groups, (33.93±2.32 vs. 33.6±2.28 respectively). Elevated AlloSure was not predictive of rejection in multiorgan heart transplant recipients. [ABSTRACT FROM AUTHOR]

The new UNOS heart allocation policy prioritizes patients with percutaneous ventricular support devices over durable LVADs. We examined one-year survival of heart transplant recipients successfully bridged with Impella versus durable LVADs in the most recent era. We retrospectively reviewed all primary adult orthotopic heart transplant recipients in the UNOS registry between Jan 1, 2016 to June 12, 2020. Recipients were identified as having an isolated durable LVAD or Impella device at the time of transplant. Those bridged with ECMO, RVAD, BIVAD, or TAH were excluded. One-year survival was examined with the Kaplan Meier method and multivariable Cox proportional hazards regression. Of 10,492 heart transplant recipients in the study period, 4610(44%) were bridged with a durable LVAD and 158(2%) with Impella. Impella use increased following the UNOS allocation policy change (3% vs 1% of transplants, p<0.01) and a higher proportion were status 1 or 2 compared to those bridged with durable LVADs (96% vs 26%, p<0.01). Median days between listing and transplant were 40, 218, and 13 days for no MCS, durable LVAD, and Impella, respectively (p<0.01). Impella-bridged recipients were less likely to be obese (26% vs 41%, p<0.01), have diabetes (24% vs 31%, p<0.01), ischemic cardiomyopathy (28% vs 35%, p<0.01), prior cardiac surgery (27% vs 73%, p<0.01), and were more likely to be on inotropes at the time of transplant (65% vs 6%, p<0.01). On multivariate analysis, neither bridge with durable LVAD (aHR 1.25, 95% CI 0.97-1.62, p = 0.08) nor Impella (aHR 1.07, 95% CI 0.55-2.08, p=0.84) was associated with a difference in one-year survival following heart transplantation. Impella utilization as bridge to transplant has tripled in the current era of heart transplantation with no significant difference in one-year survival compared to those bridged with durable LVADs. Percutaneous LVAD platforms can be cautiously considered in the sickest patients requiring LVAD bridge to transplantation. [ABSTRACT FROM AUTHOR]

Purpose Cardiac transplant surgeries can be complicated, prolonged, resource-heavy procedures that may be affected by the timing of the surgery. We analyzed data from Ronald Reagan UCLA Medical Center (RRUCLA MC) to evaluate for a "weekend effect" on mortality comparing transplant surgeries that occurred on a weekday versus during the weekend. Methods We conducted a retrospective, cohort analysis of the RR UCLA MC data for all heart-only transplant patients between from 1987 to 2018 comparing mortality rates between weekday transplants (WDT) versus weekend transplants (WET). The exclusion criteria included age <18, patients lost to follow-up, multi-organ transplants, and re-do heart transplants. A multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, race, ischemic time, need for dialysis, on life support, wait time, and HLA mismatch) was performed. Survival was censored at 12 years. Results 1,548 patients received heart transplants between 1987-2018 at RR UCLA MC, of which 1129 patients received a transplant on a weekday and 419 patients received a transplant during the weekend. Overall, the mortality for WDT and WET were 53.3% and 53.5% (p=0.89), respectively. The breakdown of cardiovascular and non-cardiovascular mortality were similar for both WDT (15.0%, 38.4%, respectively) and WET (15.3%, 38.2%) (p=0.54). Furthermore, there was no significant difference in cause of death between WDT vs WET, looking specifically at graft failure, rejection, infection, cardiovascular, malignancy, multi-organ failure, and other causes. Conclusion Based on this retrospective, cohort analysis of the RR UCLA MC data, there was no mortality "weekend effect" observed for cardiac transplantation surgeries. [ABSTRACT FROM AUTHOR]