Elsevier

Transplantation Proceedings

Volume 45, Issue 1, January–February 2013, Pages 33-37
Transplantation Proceedings

Organ donation, recovery and ischemia-reperfusion injury
Donor Brain Death Time and Impact on Outcomes in Heart Transplantation

https://doi.org/10.1016/j.transproceed.2012.08.008Get rights and content

Abstract

Introduction

Although the early effects of brain death on the organ donor are well described, there is a paucity of information on the impact of donor brain death on the transplanted recipient's heart in both the short and long term. The few studies published report conflicting results. The aim of this article was to undertake a retrospective exploratory study examining the impact of brain death in the donor on recipient outcomes with respect to the cardiac allograft, specifically looking at primary graft failure (PGF), postoperative rejection, and survival.

Methods

A total of 215 consecutive orthotopic heart transplants performed between June 2001 and March 2011 were included in this retrospective exploratory analysis.

Results

Brain death time had no association with rejection-free period or mortality in this study cohort. Use of intra-aortic balloon pump support after donor allograft implantation (assessed as an indicator of PGF) was significantly associated with brain death time (odds ratio 0.998 [95% confidence interval 0.997–0.999]; P = .023) on univariate analysis with longer brain death time associated with a lower incidence of PGF. A strong correlation between brain death time and hypoxia inducible factorenzyme activity in donor atrial tissue was found (r = .56; P = .002).

Conclusion

This study indicates that there is an association between brain death time and PGF. A longer interval from brain death may give the donor heart more time to recover from the catecholamine storm. This may have implications for donation after circulatory death donor hearts, which have not been subjected to this catecholamine storm and may potentially be less likely to suffer PGF as a result.

Section snippets

Methods

A review of prospectively collected data on all patients who underwent cardiac transplantation at our institution between June 2001 and March 2011 was performed. During this time 245 heart transplants were undertaken. Sixteen heterotopic and 14 heart lung transplants were excluded from this analysis leaving 215 patients who underwent orthotopic heart transplantation. Those 215 patients form the basis of this study. Survival data was censored on March 1, 2012. Data was collected on donor

Results

The demographics of the 215 patients who form the study cohort are outlined in Table 1. Univariate analysis of the variables associated with all cause mortality is shown in Table 2. Requirement for postoperative ECMO, preoperative creatinine, and donor age were most strongly associated with increased risk of death. Longer rejection-free period was associated with a reduced risk of death (Table 2). Brain death time was not associated with mortality, when assessed as a continuous variable or

Discussion

There are few recent studies investigating the impact of brain death time on outcomes in heart transplantation, and those that have been published report conflicting results. Despite having a larger cohort, we have been unable to replicate the findings of Odim et al of a correlation between longer brain death time and improved rejection free survival.3 In that study of pediatric recipients, Odim et al postulated that the longer brain death time allows resolution and attenuation of the

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