Is coronary atherosclerosis of the donor heart acceptable?

Objectives: Due to the shortage of donor hearts, the criteria for organ acceptability have been considerably extended and donor grafts with coronary atherosclerosis (CAS) are among those offered. This study evaluated whether and to what degree pre-existing coronary atherosclerosis may be acceptable.

Methods: 1253 consecutive heart transplant recipients were investigated retrospectively for donor-transmitted CAS (DCAS). Inclusion criteria were absence of pre-HTx angiography but performance of angiography or autopsy within 6 months after heart transplantation. DCAS was defined as ≥ 50% coronary stenosis. Hazard function and Kaplan-Meier analysis were used.

Results: In 1086 patients no DCAS was found (NDCAS group) and in 82 patients DCAS was diagnosed by angiography (n=49) or autopsy (n=33). Single-vessel DCAS was found in 53/82 patients (DCAS 1 group) and double- or triple-vessel DCAS in 26/82 patients (DCAS 2/3 group). Three of the 82 patients with DCAS were excluded since the autopsy report was unclear regarding degree of CAS; 85/1253 patients did not meet the inclusion criteria. Early after HTx the instantaneous risk of death in the NDCAS and DCAS 1 groups was 0.05 vs. 0.07 (P<0.05) whereas in the DCAS 2/3 group it was 0.42 (P>0.05 vs. NDCAS). However, beyond the first year the annual decrease in all groups was comparable (5.4%/year; 4.0%/year; 4.5%/year; all P>0.05).

Conclusion: Single-vessel CAS may be accepted in marginal donor hearts; however, revascularization (CABG, PTCA) should be considered. Donor organs with diffuse CAS have a serious risk for early graft failure. Therefore, angiographic screening should be performed in all donors ≥ 40 years old.