Does Donor’s Brain Injury Duration Have an Impact on Heart Transplantation Outcomes?

Background:

Brain death (BD) is associated with broad hemodynamic changes which might impact graft quality and patient’s survival. We aimed to test the implications of duration of donor`s brain injury and declaration of death time on heart transplantation (HTx) outcomes.

Methods:

Data on all patients who underwent HTx between 1991-2017 and are followed-up at our center were reviewed . Brain injury time (BIT) was defined as the period starting at donor’s brain injury/hospital admission to BD declaration time. Brain death interval (BDI) was defined as the period from BD to application of the donor’s aortic cross-clamp. Primary end-points were all-cause mortality and rejections. Rejections were assessed by total rejection score (TRS;0R=0,1R=1,2R=2,3R=3) and any rejection score (ARS;0R=0,1R=1,2R=1,3R=1), normalized for total biopsies. Patients were analyzed by median BIT, followed by median BDI analysis.

Results:

Patients were divided into long BIT (LongBIT) group (≥97 hours,n=86) and short BIT (ShortBIT) group (<97hours,n=87). Pre-operative and operative characteristics of the recipients and donors were similar. There were no differences in rejection scores between the ShortBIT and LongBIT groups (TRS: 0.45±0.38 vs. 0.39±0.36,p=0.46; ARS:0.39±0.31 vs. 0.36±0.41,p=0.67, respectively), as well as in the time to first rejection. Kaplan-Meier survival analysis showed that long-term survival was equal between the two groups (Figure, left panel) . Kaplan-Meier survival analysis of the two groups according to their median BDI (12 hours) yielded four groups: LongBIT & long BDI (LongBDI); Long BIT & short BDI (shortBDI); ShortBIT & LongBDI; ShortBIT & ShortBDI with no differences among them (Figure, right panel) or in time to rejection.

Conclusion: Donor’s brain injury duration does not affect mortality or rejections after HTx.