Intracerebral Bleeding in Donors Is Associated with Worsened Outcome and Reduced Short- to Midterm Survival of Heart Transplant Recipients

Background: The quality of the donor heart has a crucial effect on outcome after heart transplantation (HTx). Leading to brain dead in the end, the initial cause of death of the donor and its potential influences on organ quality are heterogenous. However, it is still controversial to which extent the donor cause of death is associated with outcome or survival post HTx.

Method: We included all patients undergoing HTx in our center between 09/2010 and 06/2021 (n = 217). Recipients were divided into five groups related to their donor cause of death: intracerebral bleeding (n = 95, 44%), traumatic brain injury (n = 54, 25%), hypoxic brain damage (n = 34, 16%), cerebrovascular (n = 15, 7%), or other cause (n = 20, 9%). Baseline characteristics, perioperative parameters, and survival were collected.

Results: Intracerebral bleeding in donors compared with traumatic brain injury is associated with higher probability of need for ECLS post HTx (35 vs. 19%, p = 0.04) and reduced survival up to 3 years post-HTx (year survival: 61 vs. 98%, p < 0.001). The effect is strongest for ICB, where survival is also significantly reduced when comparing to all other causes (year: 61 vs. 89%, p < 0.001; [Table 1]).

Table 1 Patient baseline characteristics, perioperative parameters, and survival after heart transplantation, grouped by donor cause of death

	Gr 1 (n = 95)	Gr 2 (n = 54)	Gr 3 (n = 34)	Gr 4 (n = 15)	Gr 5 (n = 20)	p
	ICB	Trauma	Hypoxic	Cerebrovascular	Other	1 vs. 2	1 vs. 3	1 vs. 4	2 vs. 3	2 vs. 4	3 vs. 4
Age (y)	55.7 ± 10.7	50.1 ± 12.2	57.9 ± 9.0	54.5 ± 10.7	58.3 ± 6.6	<0.05	ns	ns	<0.05	ns	ns
Sex (% male)	63	76	91	80	80	ns	<0.05	ns	ns	ns	ns
Dur surg. (min)	453.4 ± 124.5	419.3 ± 104.1	440.8 ± 122.6	416.0 ± 95.0	424,4 ± 107.7	ns	ns	ns	ns	ns	ns
ECLS po HTx (%)	35	19	33	20	25	<0.05	ns	ns	ns	ns	ns
Infection/Sepsis (%)	23	19	29	26.7	33	ns	ns	ns	ns	ns	ns
Survival 30 d (%)	84	100	97	93	95	<0.05	ns	ns	ns	ns	ns
Survival 90 d (%)	77	100	93	87	81	<0.001	ns	ns	ns	0,05	ns
Survival year (%)	61	98	86	79	72	<0.001	<0.05	ns	ns	<0.05	ns

Conclusion: In this retrospective analysis, donor cause of death is associated with differing outcome and survival after HTx.

Publication History

Article published online:
03 February 2022