The Impact of Donor Cardiopulmonary Resuscitation on Outcome after Heart Transplantation

Objectives: Due to excessive organ shortage, the acceptance of so-called marginal organs is discussed controversially. Donor cardiopulmonary resuscitation (CPR) is often considered to represent a contraindication for heart acceptance. With our study we wanted to analyze the impact of donor CPR on morbidity and mortality after heart transplantation (htx).

Methods: Between 10/2010 and 8/2017 89 patients underwent htx in our department. 7 of the 89 transplant recipients (7.9%) received hearts of donors with CPR prior to organ harvesting. We compared this group of patients (gr. CPR) to all other 82 patients (controls).

The donor groups were comparable besides status after CPR including cardiac function and allograft ischemia time. There were also no differences regarding the recipients’ pretransplant status.

Results: In group CPR the mean duration of donor CPR was 7.4 ± 3.3 minutes. The mean interval between CPR and organ donation was 5 ± 3 days.

Thirty-day mortality was significantly higher in the controls (13.4%) compared with 0% in group CPR.

Primary graft dysfunction (PGD) with extracorporeal life support occurred in 28.6% of patients receiving hearts after donor CPR compared with 24.4% in the control group (p>0.05).

Postoperative renal failure (71.4 vs. 36.6%), rejection > grade 1R (14.3 vs. 7.3%), and resternotomy due to bleeding (42.8 vs. 26.8%) could be found more often in gr. CPR (all p < 0.05). The duration of mechanical ventilation was also significantly prolonged in gr. CPR. However, stay on intensive care unit and in hospital were comparable between the groups.

One-year follow-up revealed a comparable morbidity but a significantly higher mortality in the controls (-year-survival in group CPR: 100%, group control: 68.1%, p < 0.05).

Conclusion: Donor CPR does not significantly affect general outcome after cardiac transplant. With regard to the small number of patients receiving resuscitated organs we could even find a better survival despite a mostly significantly increased morbidity in those patients.

Subsequently in respect of the etiology for donor CPR, it does not unconditionally represent a contraindication for organ acceptance.