(306) Regardless of Donor Cardiac Function, When Other Organs are Not Utilized, Decreased Post-Heart Transplant Survival Can Be Expected

PurposePrediction of donor heart function in heart transplant (HTx) recipients utilizes cardiac-specific parameters. However, the heart has many interactions with other organs and processes in the body via the hormonal and biochemical milieu. Using organ utilization as a surrogate for organ dysfunction, the authors sought to determine the impact on cardiac post-transplant survival (PTS) when other solid organs were not retrieved.MethodsThe UNOS database was used to identify all (n=57,450) adult (recipient listing age ≥18) HTx donor-recipient pairs in whom donor kidney (KD), liver (LI), & lung (LU) utilization disposition was recorded, from 1/1995-6/2021. Follow-up was complete to 6/2022. Survival analyses were performed to determine which donor organ(s) utilized in addition to heart (HR) were associated with improved PTS.ResultsKD were recovered in 97% (n=55,611) of donors, LI in 93% (n=53,297), & LU in 37% (n=21,129). The number of organs utilized and PTS are shown in the Table. Most commonly, HR + KD + LI were recovered (56% of all donors), followed by HR + KD + LI + LU (35% of all donors). On Kaplan-Meier analysis, recovery of each organ with the heart was associated with superior PTS than heart without the respective organ: HR ± LU (median 11.7 vs. 12.8 yr, p<0.001); HR ± LI (10.8 vs. 12.1 yr, p<0.001), HR ± KD (11.4 vs. 12.0 yr, p=0.018). Cox proportional hazards regression controlled for recipient demographics, clinical status at HTx, and era. Utilization of LI or LU - but not KD - was associated with independently lower hazards of mortality: HR + LI (0.87 [0.83-0.91]), HR + LU (0.95 [0.93-0.98]), HR + KD (0.94 [0.88-1.00]). Hazards of mortality was lower when multiple other organs were recovered: HR + 2 others (0.93 [0.89-0.98]), HR + 3 others (0.95 [0.91-0.98]).ConclusionDonor non-cardiac organ dysfunction at time of heart procurement portends inferior PTS. When other solid organs are not utilized - particularly liver & lung - worse PTS (on the order of years) can be expected. Prediction of donor heart function in heart transplant (HTx) recipients utilizes cardiac-specific parameters. However, the heart has many interactions with other organs and processes in the body via the hormonal and biochemical milieu. Using organ utilization as a surrogate for organ dysfunction, the authors sought to determine the impact on cardiac post-transplant survival (PTS) when other solid organs were not retrieved. The UNOS database was used to identify all (n=57,450) adult (recipient listing age ≥18) HTx donor-recipient pairs in whom donor kidney (KD), liver (LI), & lung (LU) utilization disposition was recorded, from 1/1995-6/2021. Follow-up was complete to 6/2022. Survival analyses were performed to determine which donor organ(s) utilized in addition to heart (HR) were associated with improved PTS. KD were recovered in 97% (n=55,611) of donors, LI in 93% (n=53,297), & LU in 37% (n=21,129). The number of organs utilized and PTS are shown in the Table. Most commonly, HR + KD + LI were recovered (56% of all donors), followed by HR + KD + LI + LU (35% of all donors). On Kaplan-Meier analysis, recovery of each organ with the heart was associated with superior PTS than heart without the respective organ: HR ± LU (median 11.7 vs. 12.8 yr, p<0.001); HR ± LI (10.8 vs. 12.1 yr, p<0.001), HR ± KD (11.4 vs. 12.0 yr, p=0.018). Cox proportional hazards regression controlled for recipient demographics, clinical status at HTx, and era. Utilization of LI or LU - but not KD - was associated with independently lower hazards of mortality: HR + LI (0.87 [0.83-0.91]), HR + LU (0.95 [0.93-0.98]), HR + KD (0.94 [0.88-1.00]). Hazards of mortality was lower when multiple other organs were recovered: HR + 2 others (0.93 [0.89-0.98]), HR + 3 others (0.95 [0.91-0.98]). Donor non-cardiac organ dysfunction at time of heart procurement portends inferior PTS. When other solid organs are not utilized - particularly liver & lung - worse PTS (on the order of years) can be expected.