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.
