Association between Centers for Disease Control €śHigh-risk €ť Donor Characteristics and Recipient Outcomes after Heart Transplantation: Insights from the UNOS Database
Alexis K.L. Okoh1, Molly Schultheis1, Kamrani K. Kambiz1, Setri Fugar2, Biruk K. Almaz1, Nikhil K. Shah1, Nicolette Stelter1, Ravindra K. Karanam1, Margarita T. Camacho1, Mark Russo1, RWJ Barnabas Health, Newark, NJ, USA1, Rush University Medical Center, Chicago, IL, USA2
OBJECTIVE: The aim of this study is to investigate the association between clinical characteristics of high-risk heart donors (HRD) and recipient outcomes after heart transplantation.
METHODS: The UNOS database was queried to identify all patients who had a heart transplant between 2004 and 2015. Recipients aged 18 and older were grouped into two based on donors risk status (HRD vs standard risk donor (SRD)). Post-transplant outcomes including episodes of acute rejection, length of stay (LOS) after transplantation and graft survival were compared between both groups. Baseline clinical characteristics including social history and viral screen findings of HRD were used for a Cox regression analysis that identified factors associated with recipient and graft survival.
RESULTS: Out of 22,333 heart transplantations performed during the study period, 2,769 (12%) patients received a HRD graft. Acute rejection episodes, LOS and graft and recipient survival were similar between both groups. HRD had the following social histories: Unprofessional tattoos or piercings (n=1722)(63%), cocaine use (n= 916)(33%), heavy smoking (n=437)(16%), heavy alcohol abuse (n= 610)(22%). Viral screens detected 72(3%) hepatitis B virus (HBV) positive,12(0.4%) hepatitis C virus (HCV) positive, and no HIV positive donors at the time of donation. Incidence of ABO donor-recipient mismatch was 404 (15%). Cox regression analysis found only donor HCV infection and ABO mismatch to be associated with poorer recipient survival.
CONSLUSIONS: Cardiac allografts from HRD who are serologically negative for viruses can be safely used without compromising recipient outcomes. A positive HCV and donor-recipient ABO mismatch are associated with worse recipient survival.