Improved long-term outcomes after heart transplantation utilizing donors with a traumatic mode of brain death.
Adult
Aged
Aged, 80 and over
Brain Death
Donor Selection
/ methods
Female
Follow-Up Studies
Graft Rejection
/ epidemiology
Heart Diseases
/ epidemiology
Heart Transplantation
/ mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Outcome Assessment, Health Care
Postoperative Complications
/ epidemiology
Prognosis
Proportional Hazards Models
Prospective Studies
Quality Improvement
Survival Rate
Tissue Donors
Wounds and Injuries
Donor
Heart transplantation
Mode of brain death
Recipient
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
22 Jul 2019
22 Jul 2019
Historique:
received:
14
05
2019
accepted:
15
07
2019
entrez:
24
7
2019
pubmed:
25
7
2019
medline:
21
11
2019
Statut:
epublish
Résumé
The donor's mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient. All patients who underwent HTx between 1996 and 2017 were categorized according to donor's BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD). The TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p = 0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42-0.75, p = 0.033]. Rejection rate was lower in the TBD group (total rejection score 0.44 ± 0.32 vs. 0.51 ± 0.38, p = 0.04; any rejection score 0.38 ± 0.26 vs. 0.45 ± 0.31, p = 0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10 years: 82.9 vs. 62.4%, log-rank p-value = 0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR) = 0.58, 95% CI 0.51-0.85, p = 0.022). Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.
Sections du résumé
BACKGROUND
BACKGROUND
The donor's mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient.
METHODS
METHODS
All patients who underwent HTx between 1996 and 2017 were categorized according to donor's BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD).
RESULTS
RESULTS
The TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p = 0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42-0.75, p = 0.033]. Rejection rate was lower in the TBD group (total rejection score 0.44 ± 0.32 vs. 0.51 ± 0.38, p = 0.04; any rejection score 0.38 ± 0.26 vs. 0.45 ± 0.31, p = 0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10 years: 82.9 vs. 62.4%, log-rank p-value = 0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR) = 0.58, 95% CI 0.51-0.85, p = 0.022).
CONCLUSION
CONCLUSIONS
Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.
Identifiants
pubmed: 31331354
doi: 10.1186/s13019-019-0963-2
pii: 10.1186/s13019-019-0963-2
pmc: PMC6647135
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
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