Donor pharmacological hemodynamic support is associated with primary graft failure in human heart transplantation

Gianluca Santise, Giuseppe D'Ancona, Calogero Falletta, Francesco Pirone, Sergio Sciacca, Marco Turrisi, Domenico Biondo, Michele Pilato

Research output: Contribution to journalArticlepeer-review

Abstract

The aim of this study was to test the impact of donor and recipient characteristics on the development of primary graft failure (PGF) after heart transplantation (HT) by focusing on the donor's inotropic support. Heart donors and matched recipients data were prospectively collected. Univariate and multivariate analyses were used to determine independent predictors for PGF and peri-operative mortality. The donor's high inotrope requirement was defined as sustained need for dopamine exceeding 10 μg/kg/min and/or alpha agonists exceeding 0.06 μg/kg/min. PGF instead was defined as need for immediate post-HT mechanical circulatory support. Since 2006, we have performed 37 HTs. PGF occurred in six patients (16.2%). Although four patients (66.6%) were weaned off circulatory support, two of them (33.3%) died on mechanical assistance. Total in-hospital mortality was 10.8% (4/37). Upon multivariate analysis, pre-harvesting donor high inotrope dosage was the major determinant for PGF (P=0.03, OR=10.8). Given the organ shortage, many centers accepted marginal hearts assuming the donor's pre-harvest hemodynamic managing has a reduced impact on PGF development. As PGF remains the most lethal postoperative complication, the hazards should be carefully considered when using pre-harvesting high inotrope infusion rates.

Original languageEnglish
Pages (from-to)476-479
Number of pages4
JournalInteractive Cardiovascular and Thoracic Surgery
Volume9
Issue number3
DOIs
Publication statusPublished - Sep 2009

Keywords

  • Heart transplant
  • Primary graft failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

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