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Donor pharmacological hemodynamic support is associated with primary graft failure in human heart transplantation

^a Department of CT Surgery, ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC (University of Pittsburgh Medical Center), Via Tricomi 1, 90127 Palermo, Italy
^b Department of Cardiology, ISMETT (Mediterranean Institute for Transplantation and Advanced Therapies), University of Pittsburgh Medical Center, Palermo, Italy
^c Office of Research, Health, and Biomedical Science, ISMETT (Mediterranean Institute for Transplantation and Advanced Therapies), University of Pittsburgh Medical Center, Palermo, Italy

*Corresponding author. Tel.: +39-091-2192111; fax: +39-091-2192354.

E-mail address: gdancona{at}ismett.edu (G. D'Ancona).

The aim of this study was to test the impact of donor and recipient characteristics on the development of primary graft failure (PGF) after heart transplantation (HT) by focusing on the donor's inotropic support. Heart donors and matched recipients data were prospectively collected. Univariate and multivariate analyses were used to determine independent predictors for PGF and peri-operative mortality. The donor's high inotrope requirement was defined as sustained need for dopamine exceeding 10 µg/kg/min and/or alpha agonists exceeding 0.06 µg/kg/min. PGF instead was defined as need for immediate post-HT mechanical circulatory support. Since 2006, we have performed 37 HTs. PGF occurred in six patients (16.2%). Although four patients (66.6%) were weaned off circulatory support, two of them (33.3%) died on mechanical assistance. Total in-hospital mortality was 10.8% (4/37). Upon multivariate analysis, pre-harvesting donor high inotrope dosage was the major determinant for PGF (P=0.03, OR=10.8). Given the organ shortage, many centers accepted marginal hearts assuming the donor's pre-harvest hemodynamic managing has a reduced impact on PGF development. As PGF remains the most lethal postoperative complication, the hazards should be carefully considered when using pre-harvesting high inotrope infusion rates.

Key Words: Primary graft failure; Heart transplant