Cardiology resident London Health Sciences Centre London, Ontario, Canada
Background: Previous studies over the past two decades had conflicting results on if prolonged donor management (case length) after death determination using neurologic criteria (DNC) affected cardiac transplant outcome.
This study aims to examine if longer case length (>72 hrs from death determination using neurologic criteria to transplant) is associated with worse cardiac transplantation outcomes.
METHODS AND RESULTS: We completed a retrospective cohort study of 188 cardiac transplants from 2010 to 2024. Donors’ and recipients’ baseline characteristics were analysed with Mann-Whitney test. 85 (45%) cases had additional baseline characteristics available from 2018 to 2024, which were also analysed with Mann-Whitney test.
Outcomes from all 188 cases were analysed with Fisher’s exact test, primary outcome was recipient death or re-transplantation within 90-days (Primary Graft Loss, PGL), and secondary outcomes were renal replacement therapy (RRT), mechanical circulatory support, and ICU free days within 90-days.
From the 188 cases at our centre, we found no important difference in baseline characteristics from 2010 to 2024 (Table 1a). From 2018 to 2024, 85 cases had additional baseline characteristics recorded, including donor total CPR time pre-transplant as well as donor maximum norepinephrine equivalent, which were also analysed, and no important differences were found (Table 1b). From 2010 to 2024, the risk of PGL significantly increased with case length >72hr. Organs with case length >72hr showed increased odds of PGL (OR 3.35, p=0.02), and increased odds of recipient RRT (OR 2.88, p=0.02), mechanical support (OR 2.63, p=0.04), fewer ICU free days within 90-days (63 vs 80 days, p< 0.01), as well decreased survival likelihood at 1 year post-transplant (58.8% vs. 85.7%, p< 0.01).
Conclusion: Longer donor case length (>72hrs) is associated with higher risk of recipient primary graft loss, need for renal replacement therapy and mechanical support, and longer ICU stay. Future studies should confirm these findings at other centres, identify and address factors contributing to donor case length, and assess if shortening donor case length improves cardiac transplantation outcomes and if other factors may be associated with PGL.
