Impact of donor origin on survival after orthotopic heart transplantation

Heart transplantation is the definitive management for select patients with end-stage heart failure in BC. Due to an ongoing organ donor shortage, organs are sometimes allocated from distant locales. These organs may be perceived as less desirable due to donor risk factors and ischemic times. We compared survival after heart transplantation in BC between 1 December 1988 and 21 October 2014 stratified by donors originating from BC, other Canadian provinces, and the US.

Among 382 patients, 297 (77.7%) recipients and 238 (62.3%) donors were male. The median recipient age was 55 years and the median donor age was 33 years. Median ischemic time was lower in BC donors (168 IQR [107.5, 228.0] min) compared with Canada (243 IQR [204.5, 291.0] min) and the US (244 IQR [217.3, 278.8] min) (P < 0.01). Overall 10-year survival was 62.1%, 95% CI [56.3, 67.4]. There was no difference in 10-year survival when comparing donors from BC, Canada, and the US (Figure) despite significantly different ischemic times. Multivariate Cox regression analysis found no relationship between origin and mortality after controlling for recipient age, donor age, and cold ischemic time.

Among patients undergoing orthotopic heart transplantation in BC, carefully selected distant-donor organs result in similar long-term outcomes despite increased ischemic times. Incorporating these findings into organ allocation protocols may extend criteria for donor selection, thereby increasing the donor pool and organ availability.
—Omid Kiamanesh, MD
—Annemarie Kaan, MCN, RN 
—Mustafa Toma, MD
Division of Cardiology, University of British Columbia

Omid Kiamanesh, MD, Annemarie Kaan, MCN, RN, Mustafa Toma, MD, FRCPC. Impact of donor origin on survival after orthotopic heart transplantation. BCMJ, Vol. 61, No. 1, January, February, 2019, Page(s) 12 - Letters.

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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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