A Contemporary Analysis of the Safety and Efficacy of Cardiac Transplantation from Donors with Blood Infections
| Autor: | Laura Piechura, Hari R. Mallidi, Morgan Harloff, Daniel Rinewalt, M. Keshk, Mitsugu Ogawa |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Transplantation medicine.medical_specialty Creatinine business.industry Proportional hazards model medicine.disease Culprit chemistry.chemical_compound chemistry Internal medicine Diabetes mellitus Cohort Circulatory system Medicine Surgery Cardiology and Cardiovascular Medicine business Cardiac transplants |
| Zdroj: | The Journal of Heart and Lung Transplantation. 39:S481 |
| ISSN: | 1053-2498 |
| Popis: | Purpose Consideration of cardiac allografts from donors with blood infections (DBI) varies widely across institutions and providers. While often discarded due to concern for infectious complications in immunocompromised recipients, these organs may represent a possible source for addressing prolonged waitlist times. Existing evidence in the literature is from prior decades; consequently, we sought to analyze the outcomes of recipients of DBI hearts using contemporary data. Methods We identified first-time, adult recipients of cardiac transplants from 2010 to 2018 using the OPTN/UNOS Standard Transplant Analysis and Research Files. Patients were classified by receipt of an organ from DBI versus those from a donor with no documented blood infection (control cohort). Information about culprit pathogen and antimicrobial therapy was not available in this dataset. Overall survival was compared using Kaplan-Meier log-rank analysis. Predictors of mortality were assessed using a Cox proportional-hazards model. Results From 2010 to 2018, 22,834 heart transplants met inclusion criteria, of which 1,982 (8.7%) involved a donor with a blood infection. Recipients were comparable in terms of age, sex, race, diagnosis, history of diabetes, serum creatinine, and proportion with mechanical circulatory support devices. Donors with blood infections were significantly older (29 vs. 28, p=0.01) and more likely to have diabetes (4% vs. 3%, p=0.02). DBI and control cohorts experienced equivalent length of index stay (16 vs. 56.5 days, p=0.051) and rates of rejection requiring treatment over their first year (p=0.40). Overall survival was equivalent (p=0.69) between DBI and control groups. Of note, Cox regression analysis revealed that blood infection was not predictive of mortality (HR 1.00, p=0.98). Predictors of mortality included age over 60 (HR 1.3, p 30 (HR 1.2, p Conclusion Adults who received first-time heart transplants from donors with blood infections from 2010 to 2018 experienced survival equivalent to controls. Although clinical judgement remains paramount, our findings discourage disqualification of an allograft due to blood infection alone. |
| Databáze: | OpenAIRE |
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