Impact of Reported Donor Ejection Fraction on Early Postoperative Mortality in Orthotopic Heart Transplantation

Objectives: The global shortage of donor organs has urged transplanting units to extend donor selection criteria clinically leading to the use of marginal donor hearts. In donors with cerebrovascular cause of brain death temporarily impaired left ventricular function (LVF) is believed to recover shortly after the index event. We analyzed retrospectively our patients after orthotopic heart transplantation (oHTX) with a focus on the outcome depending on donor LVF.

Methods: Between September 2010 and June 2020, a total of 169 oHTX were performed in our department. Donor's left ventricular ejection fraction (dLVEF) according to Eurotransplant donor report could be collected in 160 patients. In 23 cases, dLVEF was 50% or lower (46.6 ± 4.78%), which was categorized as an impaired dLVEF group. At first, the statistical analysis was performed between survival (S) and dead (D) groups to identify which preoperative parameter impacted on the first 30 days mortality in 160 patients. Further, in 66 patients, for whom recipient's left ventricular ejection fraction (rLVEF) within 90 days post oHTX was available, a correlation analysis was performed to determine the impact of dLVEF on rLVEF.

Result: A total of 142 (88.8%) and 135 (84.4%) patients survived in the first 30 and 90 days, respectively. The dLVEF and cold/warm/total ischemic time did not influence the 30-day mortality (S versus D; 59.7 ± 8.06% versus 61.6 ± 6.71%, p = 0.36, 151.0 ± 53.7 min versus 164.1 ± 37.4 min, p = 0.32, 68.3 ± 14.0 min versus 61.6 ± 14.3 min, p = 0.06, 219.3 ± 54.5 min versus 225.7 ± 35.4 min, p = 0.63, respectively), whereas only donor age was an important risk factor (S versus D, 42.4 ± 12.7 years versus 52.3 ± 9.74 years, p = 0.001). 30-day mortality was comparable between impaired dLVEF group (n = 23) and normal dLVEF group (n = 137) (p = 1.00). Upon correlation analysis, rLVEF proved independency from dLVEF (dLVEF vs. rLVEF; 60.1 ± 9.44% vs. 59.0 ± 5.35%, r = 0.20, p = 0.11).

Conclusion: Despite the limitation of the low number of donors with impaired dLVEF, our results suggest that dLVEF according to donor report might not be a strong predictor of early postoperative mortality after oHTX. In contrast, donor age appears as a definitive indispensable predictive factor for early mortality. Further detailed analysis is warranted.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021