Development of heart transplant program from donors with expanded criteria at the V.I. Shumakov National Medical Research Center of Transplantology

Vollständiger Abstract

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The use of hearts from expanded-criteria donors (ECDs) is one of the most effective strategies for increasing the number of heart transplants (HTs). At Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center), the implementation of an ECD program has enabled more rational utilization of standard-criteria donor hearts while contributing to improved early and long-term survival rates. Objective: to evaluate the early and long-term outcomes of HT using hearts from different categories of ECDs and combinations thereof. Materials and methods . An analysis of 1,500 HTs was performed, including 1,459 primary HTs (97.3%) and 41 retransplantations (2.7%), carried out at Shumakov Center between January 1, 2011, and December 31, 2021. The study population (n = 1,500) was divided into two groups: the study group, comprising recipients who underwent orthotopic heart transplantation (OHT) using hearts from ECDs (n = 1,060; 70.6%), and the control group, comprising recipients who underwent OHT using hearts from standard-criteria donors (SCDs) (n = 440; 29.4%). Results . Between 2011 and 2021, the annual number and proportion of HTs using ECD hearts at Shumakov Center increased 1.8-fold, from 46.0% (n = 17) in 2011 to 84.8% (n = 106) in 2016. Overall, in-hospital mortality did not differ significantly between the study groups (p = 0.976). However, long-term mortality was significantly higher among recipients of ECD hearts (p < 0.005). To further investigate this finding, long-term mortality was analyzed according to the number of donor risk factors. No significant difference was observed in the subgroup of donors with a single risk factor (n = 324; p = 0.351). In contrast, in the largest subgroup, comprising donors with two risk factors (n = 428), long-term mortality was significantly higher following transplantation using ECD hearts (p = 0.004). Analysis of the impact of different combinations of expanded donor criteria on long-term survival showed significantly poorer outcomes following HT from donors with the combinations of «age and hypertrophy» (p = 0.025) and «age and donor–recipient weight mismatch» (p = 0.025). Conclusion. The findings of this study demonstrate that hearts from selected categories of ECDs can be used effectively, thereby increasing the availability of HT.