A. Suarez-Pierre1, T. C. Crawford1, X. Zhou1, C. Lui1, C. D. Fraser1, E. Etchill1, K. Sharma2, R. Higgins1, G. J. Whitman1, A. Kilic1, C. W. Choi1 1Johns Hopkins University School Of Medicine,Cardiac Surgery,Baltimore, MD, USA 2Johns Hopkins University School of Medicine,Cardiology,Baltimore, MARYLAND, USA
Introduction: Heart transplant recipients of traumatically brain-injured (TBI) donors have been reported to have inferior survival and increased rates of coronary artery vasculopathy in single-center studies with limited sample sizes. This study sought to examine the impact of TBI donors on outcomes after heart transplantation.
Methods: We identified all adult heart transplants performed between January 2007 and December 2016 (inclusive) in the OPTN database. Patients undergoing repeat or heterotopic heart transplantation were excluded from the study. Recipients were dichotomized based on donor cause of death (TBI versus non-TBI), propensity-scored across 22 variables with known associations with mortality, and matched 1:1 without replacement. The primary endpoint was all-cause mortality at 1-, 3-, and 5-years after transplantation. Secondary endpoints were 3- and 5-year survival conditional on 1-year survival and rates of coronary artery vasculopathy at 1-, 3-, and 5- years after transplant.
Results: In the study period, 20,244 patients underwent heart transplantation. TBI was the primary cause of death of all donors (53.4%; 10,816/20,244) and among TBI donors, blunt injury (59.6%; 6,443/10,816) and gunshot wound (35%; 3,781/10,816) were the most common mechanisms of traumatic brain injury. Propensity matching generated 6,919 pairs with adequate covariate balance (all standardized mean differences < 0.07). Risk-adjusted survival was similar between recipients of TBI donors and non-TBI donors at 1-year (90.5% vs 90.0%, log-rank p=0.32), 3-years (84.1% vs 83.3%, log-rank p=0.25), and 5-years (78.1% vs 77.5%, log-rank p=0.34). Risk-adjusted survival conditional on 1-year survival, was also similar at 3-years (92.8% vs 92.6%, log-rank p=0.57) and 5-years (86.2% vs 86.1%, log-rank p=0.74). The risk-adjusted rates of coronary artery vasculopathy did not differ either at 1-year (8.0% vs 7.7%, log-rank p=0.60), 3-years (20.6% vs 20.4%, log-rank p=0.77), or 5-years (30.6% vs 30.4%; long-rank p=0.78).
Conclusion: In the largest analysis of TBI donors in heart transplantation, we found similar survival and rates of coronary artery vasculopathy to those who received hearts from non-TBI donors out to 5 years. These findings should allay concerns over continued transplantation with this unique donor population.
