Impact of Donor Pretreatment with Vasopressors on Outcome after Heart Transplantation

Objectives: Morbidity and mortality after heart transplantation (htx) may be the consequence of donor’s preharvest hemodynamic managing. While current guidelines advocate the administration of inotropic agents to stabilize heart-beating donors, high inotrope infusion rates often represent a contraindication for organ acceptance. The aim of our study was to analyze the impact of donor vasopressor support on outcome after htx.

Methods: Between 10/2010 and 8/2017 89 patients underwent htx in our department. With regard to donor vasopressor doses the patients could retrospectively be divided into 3 groups: a group with donor norepinephrine (NE) doses < 0.05 µg/kg/min (gr. 1), a group with doses between 0.06 and 0.19 µg/kg/min (gr. 2), and third group 3 with doses ≥ 0.2 µg/kg/min. The donor groups were comparable besides vasopressor support including cardiac function and allograft ischemia time. There were also no differences regarding the recipients’ pretransplant status.

Results: Htx was performed in 32 patients with donor NE < 0.05 µg/kg/min, groups 2 and 3 consisted of 35 and 22 patients.

Thirty-day mortality was 12.5% in group 1, 14.3 in gr. 2, and 9.1% in patients with donor NE ≥ 0.2 µg/kg/min (p > 0.05).

Primary graft dysfunction (PGD) with extracorporeal life support occurred in 25, 25.7, and 23.8% in groups 1, 2, and 3 (p > 0.05).

We did not find significant differences between the groups regarding incidence of rejection and of postoperative renal failure. Duration of mechanical ventilation, stay on intensive care unit and in hospital was slightly shortened in group 3, however without significance.

One-year-follow up revealed a comparable morbidity between the groups. However, the survival rate was significantly improved in groups 2 and 3 (74.2 and 72.2%) compared with gr. 1 (64.3%), p < 0.05.

Conclusion: Our data support the use of organs from donors with elevated vasopressor infusion rates. As the short- and midterm course of those patients was not significantly impaired, preharvesting norepinephrine doses may not serve as a contraindication for organ acceptance.