Date of Award

January 2015

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Pramod N. Bonde

Subject Area(s)

Surgery

Abstract

Background: Cardiac arrest, or downtime, can result in ischemic damage to myocardial tissue, which prompts caution in accepting hearts with such a history for transplant. Our aim is to provide guidance about whether these hearts are suitable and which among them confer optimal outcome.

Methods: We analyzed all first-time adult cardiac transplantations in the United States between 1988 and 2010 as reported in the United Network of Organ Sharing (UNOS) database. Stratification was between donors with downtime history prior to brain death versus those without such a history for univariate and multivariate analyses.

Results: Of 17,941 donors that met inclusion criteria, 700 experienced downtime. Recipients of these hearts were sicker pre-transplant: at waitlist status 1A, hospitalized, supported by ECMO, on IV inotropes, and supported by LVAD (p<0.05). They were more likely to be black, to be cigarette users, and to have had prior cardiac surgery (p<0.05). In univariate and multivariate analysis, downtime history was not associated with differences in 30-day, 1-year, or 10-year graft survival. Independent risk factors for outcome were donor age, donor BMI, donor cigarette use, recipient ECMO use, recipient use of RVAD, TAH, or bi-VAD, and black recipient ethnicity (p<0.05). Subset analysis of recipients of downtime hearts showed that donor cigarette use and black or Hispanic recipient ethnicity were associated with worse outcomes within this group (p<0.05).

Conclusions: Donor downtime does not influence survival or mortality overall; however, donor smoking history and non-white recipient ethnicity confer a worse outcome within the cohort.

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