Heart Transplantation (Videos Available)

Monday July 02, 2018 from 09:45 to 11:15

Room: N-112

323.4 Coronary angiography of potential cardiac donors increases cardiac transplantation rates (Video Available)

Andreas Zuckermann, Austria

Directot of Cardiac transplantation
Department of Cardiac Surgery
Medical University of Vienna

Abstract

Coronary Angiography of Potential Cardiac Donors Increases Cardiac Transplantation Rates

Andreas Zuckermann3, Katharina Auersperg MD3, Alexandra Kaider MD1, Michel De Pauw2, Zeljko Sutlic4, Jan Gummert5, Michael Berthold-Herz6, Christian Schulze7, Istvan Hartyanszky8, Caliskan Kadir9, Knezevic Ivan10, Jacqueline Smits11, Agita Strēlniece11, Günther Laufer3.

1Center for Medical statistics, informatics and Intelligent systems, Medical University of Vienna, Vienna, Austria; 2Department of Cardiology, Universitair Ziekenhuis Gent, Gent, Belgium; 3Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; 4Department of Cardiac Surgery, Clinical Hospital Dubrava, Zagreb, Croatia; 5Department of Cardiac Surgery, Herz und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany; 6Department of Cardiac Surgery, Herzzentrum Freiburg-Bad Krozingen, Freiburg, Germany; 7Department of Cardiology, Universitätsklinikum Jena, Jena, Germany; 8Department of Cardiac Surgery, Semmelweis University Budapest, Budapest, Hungary; 9Department of Cardiology, Erasmus Medical center, Rotterdam, Netherlands; 10Department of Cardiac Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia; 11Eurotransplant Foundation, Leiden, Netherlands

Eurotransplant Thoracic Advisory Committee.

Purpose: Donor age has increased dramatically in Europe. Preexisting coronary artery disease (CAD) and its associated complications like primary graft failure and allograft vasculopathy are major concerns in older donors. Donor coronary angiography (DCA) can detect CAD but is not regularly used in all donors. The aim of this study was to analyze whether donor angiography has an impact on heart transplantation rates.
Methods: Between 2004 and 2016 all donor heart offers registered by Eurotransplant were analyzed for DCA use and transplantation rates. DCA rates were calculated and compared corrected for various donor risk variables: age, sex, diabetes (DM), hypertension (HT), smoking history (SH) and body mass index >30 (BMI). Influence of donor risk factors on DCA results was analyzed. The likelihood of transplantation of donors with and without DCA was compared in the overall donor population as well as within risk groups. Multiple logistic regression models were created to analyze the impact of donor risk factors on DCA rates, outcome and transplantation rates. P-value of <0.05 was defined as statistically significant.
Results: A total of 12 565 donor hearts were offered during the study period. In 2319 (18.5%), DCA’s were performed. 107 DCA’s were excluded due to unclear results. Median donor age was 45 (31-53) years, 54.4% were male. 3.4% of donors had DM, 20.5% HT, 44.4% SH and 10.0% had a BMI≥30. Donor risk variables had a significant impact on DCA use: age (10 year increments (10a): p<0.0001, OR:2.88), DM (p<0.0001,OR:1.81), HT (p<0.0001,OR:1.35), SH (p<0.0001,OR:1.86), BMI (p=0.01,OR:1.24), male (p=0.0002,OR:1.24). CAD was associated with donor age (10a: p<0.0001,OR:1.55), HT (p=0.0006,OR:1.43), SH (p<0.0001,OR: 1.9), male (p<0.0001,OR:2.25). Transplant rates were significantly higher in donors with normal DCA result (compared to no DCA performed: p<0.0001,OR:2.61), whereas other independent risk factors for transplantation were: age (10a: p<0.0001, OR 0.78), DM (p=0.0019,OR:0.69), HT (p=0.002,OR:0.84), male (p<0.0001,OR:0.74) and CAD detected by DCA (p<0.0001,OR: 0.83).
Conclusion: DCA is used more often in donors with CAD risk factors and donor CAD is associated with known risk factors. Normal DCA results are associated with higher transplantation rates independent of CAD risk factors. Thus, increasing utilization of DCA, in particular in donors at high CAD risk, might increase cardiac transplantation rates.



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