Impact of Traumatically Brain-Injured Donors on Outcomes After Heart Transplantation

Alejandro Suarez-Pierre, Todd C. Crawford, Xun Zhou, Cecillia Lui, Charles D. Fraser, Eric Etchill, Kavita Sharma, Robert Higgins, Glenn Whitman, Ahmet Kilic, Chun Woo Choi

Research output: Contribution to journalArticle

Abstract

Background: Heart transplant recipients of traumatically brain-injured (TBI) donors have been reported to have inferior survival and increased rates of cardiac allograft vasculopathy in single-center studies. This study sought to examine the impact of TBI donors on outcomes after heart transplantation across all transplantation centers. Methods: We identified all adult heart transplants performed during 2007-2016 in the OPTN database. Recipients were dichotomized based on donor cause of death (TBI versus non-TBI), propensity-scored across 22 variables with known associations with mortality, and matched 1:1 without replacement. The primary endpoint was all-cause mortality. Secondary endpoints were conditional survival and rates of cardiac allograft vasculopathy. Results: In total, 20,244 patients underwent heart transplantation. TBI was the primary cause of death in 53.4% of donors (10,816/20,244), and among TBI donors, blunt injury (59.6%; 6443/10,816) and gunshot wound (35%; 3781/10,816) were the most common mechanisms of injury. Propensity matching generated 6919 pairs (all absolute mean differences < 0.07). Risk-adjusted survival was similar between recipients of TBI donors and non-TBI donors at 5 y (78.1% versus 77.5%, log-rank P = 0.34). Risk-adjusted survival conditional on 1-y survival was also similar at 5 y (86.2% versus 86.1%, log-rank P = 0.74). The 5-y risk-adjusted rates of cardiac allograft vasculopathy did not differ either (30.6% versus 30.4%; log-rank P = 0.78). Conclusions: In the largest analysis of TBI donors in heart transplantation, we found similar survival and rates of cardiac allograft vasculopathy to those who received hearts from non-TBI donors out to 5 y. These findings should allay concerns over continued transplantation with this unique donor population.

Original languageEnglish (US)
Pages (from-to)40-47
Number of pages8
JournalJournal of Surgical Research
Volume240
DOIs
StatePublished - Aug 1 2019

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Heart Transplantation
Tissue Donors
Brain
Allografts
Survival Rate
Survival
Cause of Death
Transplantation
Gunshot Wounds
Nonpenetrating Wounds
Mortality
Databases
Transplants
Wounds and Injuries

Keywords

  • Cardiac allograft vasculopathy
  • Heart transplantation
  • Organ allocation
  • Organ donation
  • Propensity matching
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of Traumatically Brain-Injured Donors on Outcomes After Heart Transplantation. / Suarez-Pierre, Alejandro; Crawford, Todd C.; Zhou, Xun; Lui, Cecillia; Fraser, Charles D.; Etchill, Eric; Sharma, Kavita; Higgins, Robert; Whitman, Glenn; Kilic, Ahmet; Choi, Chun Woo.

In: Journal of Surgical Research, Vol. 240, 01.08.2019, p. 40-47.

Research output: Contribution to journalArticle

Suarez-Pierre, Alejandro ; Crawford, Todd C. ; Zhou, Xun ; Lui, Cecillia ; Fraser, Charles D. ; Etchill, Eric ; Sharma, Kavita ; Higgins, Robert ; Whitman, Glenn ; Kilic, Ahmet ; Choi, Chun Woo. / Impact of Traumatically Brain-Injured Donors on Outcomes After Heart Transplantation. In: Journal of Surgical Research. 2019 ; Vol. 240. pp. 40-47.
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abstract = "Background: Heart transplant recipients of traumatically brain-injured (TBI) donors have been reported to have inferior survival and increased rates of cardiac allograft vasculopathy in single-center studies. This study sought to examine the impact of TBI donors on outcomes after heart transplantation across all transplantation centers. Methods: We identified all adult heart transplants performed during 2007-2016 in the OPTN database. Recipients were dichotomized based on donor cause of death (TBI versus non-TBI), propensity-scored across 22 variables with known associations with mortality, and matched 1:1 without replacement. The primary endpoint was all-cause mortality. Secondary endpoints were conditional survival and rates of cardiac allograft vasculopathy. Results: In total, 20,244 patients underwent heart transplantation. TBI was the primary cause of death in 53.4{\%} of donors (10,816/20,244), and among TBI donors, blunt injury (59.6{\%}; 6443/10,816) and gunshot wound (35{\%}; 3781/10,816) were the most common mechanisms of injury. Propensity matching generated 6919 pairs (all absolute mean differences < 0.07). Risk-adjusted survival was similar between recipients of TBI donors and non-TBI donors at 5 y (78.1{\%} versus 77.5{\%}, log-rank P = 0.34). Risk-adjusted survival conditional on 1-y survival was also similar at 5 y (86.2{\%} versus 86.1{\%}, log-rank P = 0.74). The 5-y risk-adjusted rates of cardiac allograft vasculopathy did not differ either (30.6{\%} versus 30.4{\%}; log-rank P = 0.78). Conclusions: In the largest analysis of TBI donors in heart transplantation, we found similar survival and rates of cardiac allograft vasculopathy to those who received hearts from non-TBI donors out to 5 y. These findings should allay concerns over continued transplantation with this unique donor population.",
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AU - Suarez-Pierre, Alejandro

AU - Crawford, Todd C.

AU - Zhou, Xun

AU - Lui, Cecillia

AU - Fraser, Charles D.

AU - Etchill, Eric

AU - Sharma, Kavita

AU - Higgins, Robert

AU - Whitman, Glenn

AU - Kilic, Ahmet

AU - Choi, Chun Woo

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AB - Background: Heart transplant recipients of traumatically brain-injured (TBI) donors have been reported to have inferior survival and increased rates of cardiac allograft vasculopathy in single-center studies. This study sought to examine the impact of TBI donors on outcomes after heart transplantation across all transplantation centers. Methods: We identified all adult heart transplants performed during 2007-2016 in the OPTN database. Recipients were dichotomized based on donor cause of death (TBI versus non-TBI), propensity-scored across 22 variables with known associations with mortality, and matched 1:1 without replacement. The primary endpoint was all-cause mortality. Secondary endpoints were conditional survival and rates of cardiac allograft vasculopathy. Results: In total, 20,244 patients underwent heart transplantation. TBI was the primary cause of death in 53.4% of donors (10,816/20,244), and among TBI donors, blunt injury (59.6%; 6443/10,816) and gunshot wound (35%; 3781/10,816) were the most common mechanisms of injury. Propensity matching generated 6919 pairs (all absolute mean differences < 0.07). Risk-adjusted survival was similar between recipients of TBI donors and non-TBI donors at 5 y (78.1% versus 77.5%, log-rank P = 0.34). Risk-adjusted survival conditional on 1-y survival was also similar at 5 y (86.2% versus 86.1%, log-rank P = 0.74). The 5-y risk-adjusted rates of cardiac allograft vasculopathy did not differ either (30.6% versus 30.4%; log-rank P = 0.78). Conclusions: In the largest analysis of TBI donors in heart transplantation, we found similar survival and rates of cardiac allograft vasculopathy to those who received hearts from non-TBI donors out to 5 y. These findings should allay concerns over continued transplantation with this unique donor population.

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KW - Traumatic brain injury

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