Cardiac transplantation from infected donors: Is it safe?

Stephen J. Forest, Patricia Friedmann, Ricardo Bello, Daniel J. Goldstein, Victoria Muggia, David A. D'Alessandro

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Transplantation of a cardiac allograft from an infected donor risks transmission of disease to the immunocompromised recipient. Such organs are often not utilized despite little supporting evidence. We sought to evaluate outcomes following cardiac transplant with the use of an infected allograft. Methods The UNOS/OPTN database was used to identify first time, adult heart transplant recipients from 1995 to 2009. Patients receiving allografts from blood culture positive donor (CPD) were compared to those who did not (NCPD). Results A total of 26,813 recipients were included. Nine hundred ninety-five (3.7%) received a heart from a CPD. Recipients of hearts from CPDs were more likely to be diabetic (24% vs. 20%, p-=-0.01), hypertensive (42% vs. 38%, p-=-0.02), status 1 (80% vs. 76%, p-=-0.0021), have a BMI->-30 (19% vs. 16%, p-=-0.001), on intra-aortic balloon pump (IABP) support (7% vs. 5%, p-=-0.017), and worse functional status. Recipients with a CPD were more likely to be treated for a post-transplant infection (28% vs. 23%, p-=-0.003) but not for an episode of rejection in the first year after transplantation (39% vs. 40%, p-=-0.73). Receipt of a CPD allograft was not a multivariate predictor for mortality. CPD and NCPD survival was similar at one year (86% vs. 87%, p-=-0.2585) and 15 years (34% vs. 36%, p-=-0.0929). Conclusion Use of allografts from CPD has no influence on survival despite the fact that these recipients tend to have a higher acuity and more comorbidities at the time of transplantation. Utilization of a heart from a donor with a confirmed blood stream infection should be carefully considered. doi: 10.1111/jocs.12509 (J Card Surg 2015;30:288-295)

Original languageEnglish (US)
Pages (from-to)288-295
Number of pages8
JournalJournal of Cardiac Surgery
Volume30
Issue number3
DOIs
StatePublished - Mar 1 2015

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Heart Transplantation
Tissue Donors
Allografts
Transplantation
Transplants
Survival
Infection
Comorbidity
Databases
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cardiac transplantation from infected donors : Is it safe? / Forest, Stephen J.; Friedmann, Patricia; Bello, Ricardo; Goldstein, Daniel J.; Muggia, Victoria; D'Alessandro, David A.

In: Journal of Cardiac Surgery, Vol. 30, No. 3, 01.03.2015, p. 288-295.

Research output: Contribution to journalArticle

Forest, Stephen J. ; Friedmann, Patricia ; Bello, Ricardo ; Goldstein, Daniel J. ; Muggia, Victoria ; D'Alessandro, David A. / Cardiac transplantation from infected donors : Is it safe?. In: Journal of Cardiac Surgery. 2015 ; Vol. 30, No. 3. pp. 288-295.
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title = "Cardiac transplantation from infected donors: Is it safe?",
abstract = "Background Transplantation of a cardiac allograft from an infected donor risks transmission of disease to the immunocompromised recipient. Such organs are often not utilized despite little supporting evidence. We sought to evaluate outcomes following cardiac transplant with the use of an infected allograft. Methods The UNOS/OPTN database was used to identify first time, adult heart transplant recipients from 1995 to 2009. Patients receiving allografts from blood culture positive donor (CPD) were compared to those who did not (NCPD). Results A total of 26,813 recipients were included. Nine hundred ninety-five (3.7{\%}) received a heart from a CPD. Recipients of hearts from CPDs were more likely to be diabetic (24{\%} vs. 20{\%}, p-=-0.01), hypertensive (42{\%} vs. 38{\%}, p-=-0.02), status 1 (80{\%} vs. 76{\%}, p-=-0.0021), have a BMI->-30 (19{\%} vs. 16{\%}, p-=-0.001), on intra-aortic balloon pump (IABP) support (7{\%} vs. 5{\%}, p-=-0.017), and worse functional status. Recipients with a CPD were more likely to be treated for a post-transplant infection (28{\%} vs. 23{\%}, p-=-0.003) but not for an episode of rejection in the first year after transplantation (39{\%} vs. 40{\%}, p-=-0.73). Receipt of a CPD allograft was not a multivariate predictor for mortality. CPD and NCPD survival was similar at one year (86{\%} vs. 87{\%}, p-=-0.2585) and 15 years (34{\%} vs. 36{\%}, p-=-0.0929). Conclusion Use of allografts from CPD has no influence on survival despite the fact that these recipients tend to have a higher acuity and more comorbidities at the time of transplantation. Utilization of a heart from a donor with a confirmed blood stream infection should be carefully considered. doi: 10.1111/jocs.12509 (J Card Surg 2015;30:288-295)",
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T2 - Is it safe?

AU - Forest, Stephen J.

AU - Friedmann, Patricia

AU - Bello, Ricardo

AU - Goldstein, Daniel J.

AU - Muggia, Victoria

AU - D'Alessandro, David A.

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N2 - Background Transplantation of a cardiac allograft from an infected donor risks transmission of disease to the immunocompromised recipient. Such organs are often not utilized despite little supporting evidence. We sought to evaluate outcomes following cardiac transplant with the use of an infected allograft. Methods The UNOS/OPTN database was used to identify first time, adult heart transplant recipients from 1995 to 2009. Patients receiving allografts from blood culture positive donor (CPD) were compared to those who did not (NCPD). Results A total of 26,813 recipients were included. Nine hundred ninety-five (3.7%) received a heart from a CPD. Recipients of hearts from CPDs were more likely to be diabetic (24% vs. 20%, p-=-0.01), hypertensive (42% vs. 38%, p-=-0.02), status 1 (80% vs. 76%, p-=-0.0021), have a BMI->-30 (19% vs. 16%, p-=-0.001), on intra-aortic balloon pump (IABP) support (7% vs. 5%, p-=-0.017), and worse functional status. Recipients with a CPD were more likely to be treated for a post-transplant infection (28% vs. 23%, p-=-0.003) but not for an episode of rejection in the first year after transplantation (39% vs. 40%, p-=-0.73). Receipt of a CPD allograft was not a multivariate predictor for mortality. CPD and NCPD survival was similar at one year (86% vs. 87%, p-=-0.2585) and 15 years (34% vs. 36%, p-=-0.0929). Conclusion Use of allografts from CPD has no influence on survival despite the fact that these recipients tend to have a higher acuity and more comorbidities at the time of transplantation. Utilization of a heart from a donor with a confirmed blood stream infection should be carefully considered. doi: 10.1111/jocs.12509 (J Card Surg 2015;30:288-295)

AB - Background Transplantation of a cardiac allograft from an infected donor risks transmission of disease to the immunocompromised recipient. Such organs are often not utilized despite little supporting evidence. We sought to evaluate outcomes following cardiac transplant with the use of an infected allograft. Methods The UNOS/OPTN database was used to identify first time, adult heart transplant recipients from 1995 to 2009. Patients receiving allografts from blood culture positive donor (CPD) were compared to those who did not (NCPD). Results A total of 26,813 recipients were included. Nine hundred ninety-five (3.7%) received a heart from a CPD. Recipients of hearts from CPDs were more likely to be diabetic (24% vs. 20%, p-=-0.01), hypertensive (42% vs. 38%, p-=-0.02), status 1 (80% vs. 76%, p-=-0.0021), have a BMI->-30 (19% vs. 16%, p-=-0.001), on intra-aortic balloon pump (IABP) support (7% vs. 5%, p-=-0.017), and worse functional status. Recipients with a CPD were more likely to be treated for a post-transplant infection (28% vs. 23%, p-=-0.003) but not for an episode of rejection in the first year after transplantation (39% vs. 40%, p-=-0.73). Receipt of a CPD allograft was not a multivariate predictor for mortality. CPD and NCPD survival was similar at one year (86% vs. 87%, p-=-0.2585) and 15 years (34% vs. 36%, p-=-0.0929). Conclusion Use of allografts from CPD has no influence on survival despite the fact that these recipients tend to have a higher acuity and more comorbidities at the time of transplantation. Utilization of a heart from a donor with a confirmed blood stream infection should be carefully considered. doi: 10.1111/jocs.12509 (J Card Surg 2015;30:288-295)

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