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The Annals of Thoracic Surgery, Vol 57, 76-81, Copyright © 1994 by The Society of Thoracic Surgeons
GY Ott, RE Herschberger, RR Ratkovec, D Norman, JD Hosenpud and A Cobanoglu
Rising waiting list mortality and increasing demand for donor organs have
led to extension of traditionally accepted criteria for evaluation of
cardiac grafts. From December 1985 to June 1992, 188 cardiac grafts were
orthotopically transplanted into 178 recipients. Of these grafts, 38.3%
(72/188) were defined as high-risk donors. Risk criteria included prolonged
cardiopulmonary resuscitation, age greater than 40 years, high inotrope
requirements, undersizing by more than 20% body weight, significant wall
motion impairment by echocardiography, elevation of myocardial enzyme
levels, and cold ischemia time greater than 4 hours. There were no
recipient deaths attributable to primary graft failure in the perioperative
period. Operative (30-day), 1-year and 5-year survival was 95.5%, 86.1%,
and 77.3%, respectively, in the high-risk group compared with 93.7%, 86.0%,
and 67.2%, respectively, in the low- risk donor cohort (p = 0.94).
Comparison of duration of postoperative inotrope use, intensive care unit
stay, total hospital stay, and in- hospital costs revealed no significant
trends favoring either group in postoperative morbidity. Among long-term
survivors, development of graft coronary disease was noted in 47.1% (24/51)
of the high-risk donor group and only 17.4% (12/69) of the remaining group
(p = 0.0005). Left ventricular ejection fractions in the high risk donor
group were 0.58 +/- 0.01 at 2 years. Review of this series suggests that
selective use of apparently compromised cardiac donors is compatible with
excellent cardiac function and survival. Higher incidence of graft
vasculopathy may cause significant morbidity during late follow-up.
ARTICLES
Cardiac allografts from high-risk donors: excellent clinical results
Oregon Cardiac Transplant Program, Oregon Health Sciences University, Portland 97201-3098.
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