1
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Tapaskar N, Wayda B, Malinoski D, Luikart H, Groat T, Nguyen J, Belcher J, Nieto J, Neidlinger N, Salehi A, Geraghty PJ, Nicely B, Jendrisak M, Pearson T, Wood RP, Zhang S, Weng Y, Zaroff J, Khush KK. Donor Electrocardiogram Associations With Cardiac Dysfunction, Heart Transplant Use, and Survival: The Donor Heart Study. JACC. HEART FAILURE 2024; 12:722-736. [PMID: 38244008 DOI: 10.1016/j.jchf.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Potential organ donors often exhibit abnormalities on electrocardiograms (ECGs) after brain death, but the physiological and prognostic significance of such abnormalities is unknown. OBJECTIVES This study sought to characterize the prevalence of ECG abnormalities in a nationwide cohort of potential cardiac donors and their associations with cardiac dysfunction, use for heart transplantation (HT), and recipient outcomes. METHODS The Donor Heart Study enrolled 4,333 potential cardiac organ donors at 8 organ procurement organizations across the United States from 2015 to 2020. A blinded expert reviewer interpreted all ECGs, which were obtained once hemodynamic stability was achieved after brain death and were repeated 24 ± 6 hours later. ECG findings were summarized, and their associations with other cardiac diagnostic findings, use for HT, and graft survival were assessed using univariable and multivariable regression. RESULTS Initial ECGs were interpretable for 4,136 potential donors. Overall, 64% of ECGs were deemed clinically abnormal, most commonly as a result of a nonspecific St-T-wave abnormality (39%), T-wave inversion (19%), and/or QTc interval >500 ms (17%). Conduction abnormalities, ectopy, pathologic Q waves, and ST-segment elevations were less common (each present in ≤5% of donors) and resolved on repeat ECGs in most cases. Only pathological Q waves were significant predictors of donor heart nonuse (adjusted OR: 0.39; 95% CI: 0.29-0.53), and none were associated with graft survival at 1 year post-HT. CONCLUSIONS ECG abnormalities are common in potential heart donors but often resolve on serial testing. Pathologic Q waves are associated with a lower likelihood of use for HT, but they do not portend worse graft survival.
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Affiliation(s)
- Natalie Tapaskar
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | - Brian Wayda
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Darren Malinoski
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Helen Luikart
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Tahnee Groat
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - John Nguyen
- Division of Transplant Surgery, Department of Surgery, University of California-San Francisco, San Francisco, California, USA
| | - John Belcher
- New England Donor Services, Waltham, Massachusetts, USA
| | - Javier Nieto
- LifeGift Organ Procurement Organization, Houston, Texas, USA
| | - Nikole Neidlinger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | | | - Martin Jendrisak
- Gift of Hope Organ and Tissue Donor Network, Itasca, Illinois, USA
| | | | - R Patrick Wood
- LifeGift Organ Procurement Organization, Houston, Texas, USA
| | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Zaroff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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2
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Rahm AK, Helmschrott M, Darche FF, Thomas D, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival. ESC Heart Fail 2021; 8:3737-3747. [PMID: 34213089 PMCID: PMC8497214 DOI: 10.1002/ehf2.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Right bundle branch block (RBBB) after heart transplantation (HTX) is a common finding, but its impact on post‐transplant survival remains uncertain. This study investigated the post‐transplant outcomes of patients with complete RBBB (cRBBB) ≤ 30 days after HTX. Methods This registry study analysed 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis of cRBBB ≤ 30 days after HTX. Analysis included recipient and donor data, medication, echocardiographic features, graft rejections, atrial fibrillation, heart rates, permanent pacemaker implantation and mortality after HTX including causes of death. Results One hundred thirty‐nine patients showed cRBBB ≤ 30 days after HTX (21.8%), 20 patients with pre‐existing cRBBB in the donor heart (3.2%) and 119 patients with newly acquired cRBBB (18.6%). Patients with newly acquired cRBBB had a worse 1‐year post‐transplant survival (36.1%, P < 0.01) compared with patients with pre‐existing cRBBB (85.0%) or without cRBBB (86.4%), along with a higher percentage of death due to graft failure (P < 0.01). Multivariate analysis indicated cRBBB ≤ 30 days after HTX as significant risk factor for 1‐year mortality after HTX (HR: 2.20; 95% CI: 1.68–2.87; P < 0.01). Secondary outcomes showed a higher rate of an enlarged right atrium (P = 0.01), enlarged right ventricle (P < 0.01), reduced right ventricular function (P < 0.01), 30‐day atrial fibrillation (P < 0.01) and 1‐year permanent pacemaker implantation (P = 0.02) in patients with cRBBB after HTX. Conclusions Newly acquired cRBBB early after HTX is associated with increased post‐transplant mortality.
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Affiliation(s)
- Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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3
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McCulloch MA, Zuckerman WA, Möller T, Knecht K, Lin KY, Beasley GS, Peng DM, Albert DC, Miera O, Dipchand AI, Kirk R, Davies RR. Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: A review of the literature. Pediatr Transplant 2020; 24:e13676. [PMID: 32198808 DOI: 10.1111/petr.13676] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/12/2020] [Accepted: 01/21/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Heart transplantation has become standard of care for pediatric patients with either end-stage heart failure or inoperable congenital heart defects. Despite increasing surgical complexity and overall volume, however, annual transplant rates remain largely unchanged. Data demonstrating pediatric donor heart refusal rates of 50% suggest optimizing donor utilization is critical. This review evaluated the impact of donor characteristics surrounding the time of death on pediatric heart transplant recipient outcomes. METHODS An extensive literature review was performed to identify articles focused on donor characteristics surrounding the time of death and their impact on pediatric heart transplant recipient outcomes. RESULTS Potential pediatric heart transplant recipient institutions commonly receive data from seven different donor death-related categories with which to determine organ acceptance: cause of death, need for CPR, serum troponin, inotrope exposure, projected donor ischemia time, electrocardiographic, and echocardiographic results. Although DITs up to 8 hours have been reported with comparable recipient outcomes, most data support minimizing this period to <4 hours. CVA as a cause of death may be associated with decreased recipient survival but is rare in the pediatric population. Otherwise, however, in the setting of an acceptable donor heart with a normal echocardiogram, none of the other data categories surrounding donor death negatively impact pediatric heart transplant recipient survival. CONCLUSIONS Echocardiographic evaluation is the most important donor clinical information following declaration of brain death provided to potential recipient institutions. Considering its relative importance, every effort should be made to allow direct image visualization.
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Affiliation(s)
| | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, NY, USA
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Kimberly Y Lin
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Dimpna C Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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4
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Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
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Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
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5
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Kimura Y, Seguchi O, Iwasaki K, Toda K, Kikuchi N, Matsuda S, Kumai Y, Kuroda K, Wada K, Matsumoto Y, Fukushima S, Yanase M, Fujita T, Kobayashi J, Fukushima N. Impact of Coronary Artery Calcification in the Donor Heart on Transmitted Coronary Artery Disease in Heart Transplant Recipients. Circ J 2018; 82:3021-3028. [PMID: 30270311 DOI: 10.1253/circj.cj-18-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) after heart transplantation (HTx) develops as a combination of donor-transmitted coronary atherosclerosis (DTCA) and cardiac allograft vasculopathy. Assessing donor CAD before procurement is important. Because coronary artery calcification (CAC) is a predictor for CAD, donor-heart CAC is usually evaluated to estimate the risk of donor CAD. The usefulness of CAC for predicting DTCA, however, is not known. Methods and Results: Sixty-four HTx recipients whose donor underwent chest computed tomography before procurement or ≤2 weeks after HTx and who underwent coronary angiography and intravascular ultrasound (IVUS) ≤3 months after HTx were enrolled. Eight patients had CAC (CAC group) and 56 patients did not have CAC (no-CAC group). Patients in the CAC group were significantly older and had a higher prevalence of maximum intimal thickness (MIT) of the coronary artery ≥0.5 mm at initial IVUS than patients in the no-CAC group (100% vs. 55%, P=0.02). Adverse cardiac events and death were not significantly different. Everolimus tended to be used more often in the CAC group. CONCLUSIONS Donor-heart CAC is a significant predictor for MIT of the coronary artery ≥0.5 mm after HTx. The presence of CAC, however, is not associated with future cardiac events. The higher prevalence of everolimus use in the CAC group may have affected the results.
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Affiliation(s)
- Yuki Kimura
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Osamu Seguchi
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Keiichiro Iwasaki
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Noriko Kikuchi
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Sachi Matsuda
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Yuto Kumai
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Kensuke Kuroda
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Kyoichi Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Norihide Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center
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6
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Dorent R, Gandjbakhch E, Goéminne C, Ivanes F, Sebbag L, Bauer F, Epailly E, Boissonnat P, Nubret K, Amour J, Vermes E, Ou P, Guendouz S, Chevalier P, Lebreton G, Flecher E, Obadia JF, Logeart D, de Groote P. Assessment of potential heart donors: A statement from the French heart transplant community. Arch Cardiovasc Dis 2017; 111:126-139. [PMID: 29277435 DOI: 10.1016/j.acvd.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
Abstract
Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors.
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Affiliation(s)
- Richard Dorent
- Agence de la biomédecine, direction prélèvement greffe organes-tissus, 1, avenue du Stade-de-France, 93212 Saint-Denis-La-Plaine cedex, France.
| | - Estelle Gandjbakhch
- Département de cardiologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Céline Goéminne
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
| | - Fabrice Ivanes
- Service de cardiologie, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Laurent Sebbag
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Fabrice Bauer
- Département de cardiologie, hôpital Charles-Nicolle, centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Eric Epailly
- Service de chirurgie cardiaque, nouvel hôpital civil, centre hospitalier universitaire de Strasbourg, 67091 Strasbourg, France
| | - Pascale Boissonnat
- Pôle médicochirurgical de transplantation cardiaque adulte, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Karine Nubret
- Département d'anesthésie-réanimation II, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France
| | - Julien Amour
- Département d'anesthésie-réanimation, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Emmanuelle Vermes
- Service de chirurgie cardiaque, hôpital Trousseau, centre hospitalier régional et universitaire de Tours, 37170 Tours, France
| | - Phalla Ou
- Département de radiologie, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75877 Paris, France
| | - Soulef Guendouz
- Département de cardiologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France
| | - Philippe Chevalier
- Service de rythmologie, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Guillaume Lebreton
- Service de chirurgie cardiovasculaire, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Erwan Flecher
- Service de chirurgie cardiovasculaire, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - Jean-François Obadia
- Service de chirurgie cardiovasculaire, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France
| | - Damien Logeart
- Département de cardiologie, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75475 Paris, France
| | - Pascal de Groote
- Service de cardiologie, hôpital cardiologique, centre hospitalier régional et universitaire de Lille, 59000 Lille, France
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7
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Mancini D, Goldstein D, Taylor S, Chen L, Gass A, DeLair S, Pinney S. Maximizing donor allocation: A review of UNOS region 9 donor heart turn-downs. Am J Transplant 2017; 17:3193-3198. [PMID: 28898542 DOI: 10.1111/ajt.14499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/23/2017] [Accepted: 09/06/2017] [Indexed: 01/25/2023]
Abstract
This study was performed to determine if organ selection practices for heart utilization by Region 9 transplant programs were optimal, and to identify opportunities to increase local organ recovery. A retrospective review of de-identified region-wide donor data January 1, 2010 through December 31, 2013 was performed. Over the study period 537 heart donors were identified, of which 321 (60%) were transplanted. Two hundred-sixteen consented hearts were not used; 190 of these were not recovered, and 26 were recovered but not transplanted. Of these, 245/321 (76%) hearts were transplanted at one of 5 regional programs, 15 (5%) were transplanted out of region as primary offers, and 61 (19%) were turned down in region and exported. Of the 61 exported hearts, 43 were turned down in region for donor-related "quality" codes (UNOS 830, 833-837) by at least one program, the remaining 18 hearts were turned down for non-"quality" reasons, primarily histocompatibility and size. Only 5/43 exported were turned down for "quality" reasons by all regional programs offered the organ. A review of consented, not recovered donor offers suggested an additional 28 organs were possibly appropriate for transplant. Our review of regional turn-downs suggests transplant centers could potentially identify additional usable organs without compromising short-term outcomes.
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Affiliation(s)
- Donna Mancini
- Mount Sinai Medical Center, New York, NY, USA.,Columbia University Medical Center, New York, NY, USA
| | | | - Samantha Taylor
- New York Cardiothoracic Transplant Consortium, Inc., Troy, NY, USA
| | - Leway Chen
- University of Rochester Medical Center, Rochester, NY, USA
| | - Alan Gass
- Westchester Medical Center, Valhalla, NY, USA
| | - Samantha DeLair
- New York Cardiothoracic Transplant Consortium, Inc., Troy, NY, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, NY, USA
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8
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Champigneulle B, Charpentier J. Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s). MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Pickham D, Hickey K, Doering L, Chen B, Castillo C, Drew BJ. Electrocardiographic abnormalities in the first year after heart transplantation. J Electrocardiol 2013; 47:135-9. [PMID: 24119878 DOI: 10.1016/j.jelectrocard.2013.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 10/26/2022]
Abstract
STUDY AIM Describe ECG abnormalities in the first year following transplant surgery. METHODS Analysis of 12-lead ECGs from heart transplant subjects enrolled in an ongoing multicenter clinical trial. RESULTS 585 ECGs from 98 subjects showed few with abnormal cardiac rhythm (99% of ECGs were sinus rhythm/tachycardia). A majority of subjects (69%) had either right intraventricular conduction delay (56%) or right bundle branch block (13%). A second prevalent ECG abnormality was atrial enlargement (64% of subjects) that was more commonly left atrial (55%) than right (30%). CONCLUSIONS Right intraventricular conduction delay or right bundle branch block is prevalent in heart transplant recipients in the first year following transplant surgery. Whether this abnormality is related to acute allograph rejection or endomyocardial biopsy procedures is the subject of the ongoing clinical trial. Atrial enlargement ECG criteria (especially, left atrial) are also common and are likely due to transplant surgery with subsequent atrial remodeling.
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Affiliation(s)
- David Pickham
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Lynn Doering
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Belinda Chen
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Barbara J Drew
- University of California, San Francisco, San Francisco, CA, USA.
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