Does the Duration of Donor-Stay on ICU Impact the Outcome after Heart Transplantation?

Background: In the majority of potential organ donors, brain death is diagnosed within the first 7 days after hospital admission. However, a significant group of donors stays longer than 7 days on ICU, suffering from typical ICU risks like pneumonia, renal failure, or further infections. Our aim is to analyze the impact of duration of stay on ICU before organ donation on outcome after cardiac transplantation.

Method: Between September 2010 and September 2021, a total of 225 patients underwent heart transplantation (HTX) in our department. With regard to the duration of donor-stay on ICU before organ harvesting, patients could retrospectively be divided into two groups: duration of ICU stay ≤ 7 days (group 1) and donor-stay on ICU > 7 days (group 2). The recipient groups were comparable regarding the underlying disease, preoperative ECLS and allograft ischemia time. Most donor criteria were comparable between the groups, i.e., age, gender, CMV status, and LV-EF.

Results: Group 1 consisted of 163 patients, and group 2 consisted of 62 patients. Interestingly, 33.7% of donors in group 1 underwent former resuscitation before donation, 14.5% in group 2 (p < 0.05). Thirty-day mortality was 10.5% in group 1 and 6.8% in group 2. Stay on ICU and in-hospital and mechanical ventilation was prolonged in group 2 (p > 0.05). Patients in group 1 displayed a slightly higher incidence of extracorporeal life support (ECLS) after HTX (p < 0.05). We did not find significant differences between the groups regarding incidence of rejection, infection or postoperative renal failure. Group 2 patients suffered significantly more often from neurological complications after HTX. One-year survival was 79.5% in group 1 and 76.5% in group 2 (p > 0.05).

Conclusion: With our results, we could show that the duration of donor ICU stay does not influence short and midterm outcome after heart transplantation. Knowing the typical pathologies on ICU, this observation may be the consequence of an optimized medical donor care.

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Artikel online veröffentlicht:
03. Februar 2022