Single-Center Experience with Frequent Use of Organs after Rescue Allocation for Heart Transplantation: Can We Still Achieve Reasonable Results?

Objectives: The number of patients on the heart waiting list in the ET-region is almost 3-fold higher than the number of patients who will actually undergo heart transplantation (htx). Consequently waiting times continue to increase and can be beyond a year even for high-urgent (HU)-listed patients. One possible solution for an increased donor pool is the acceptance of so-called marginal organs.

This analysis deals with the effect of frequently using organs after rescue allocation for cardiac transplant in our department.

Methods: Between 10/2010 and 8/2017, eighty-nine patients underwent htx in our department. 45 of the 89 transplant recipients (50.6%) were transplanted with HU-allocations (group HU), the remaining patients received organs after rescue allocation (gr. T). These organs had been rejected by at least three consecutive transplant centers due to medical reasons.

Perioperative parameters of donor and recipient and posttransplant outcomes were compared between these 2 groups.

Results: Mean donor age was higher in group T (p < 0.05), whereas donor ejection fraction was slightly lower (p>0.05). All other donor parameters (CMV status, time of ischemia as well as sex) were comparable between the groups.

30-day mortality was significantly higher in HU-patients (15.6%) compared with 9.1% after rescue allocation.

Primary graft dysfunction (PGD) with extracorporeal life support occurred in 33.3% after HU-transplantation and in 15.9% of gr. T (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 were significantly prolonged in group HU.

1-year-follow up revealed a comparable morbidity and mortality between the groups (-year-survival in group HU: 71.1%, group T: 69.2%, p>0.05).

Conclusion: Our data support the use of hearts after rescue allocation. Probably as a consequence of the impaired clinical status of HU-recipients, early mortality was lower in patients after receiving rescue organs. However, one-year survival was comparable again, indicating a yet remarkable mortality in those patients beyond the first postoperative month.