Objectives: To investigate the association between invasive hemodynamic measurements of cardiac donors and post-transplantation mortality of recipients.
Methods: We queried the United Network for Organ Sharing registry for all adult recipients of cardiac allografts with pre-transplant invasive hemodynamic assessment (2000-2015). Each abnormal hemodynamics measurement was assigned 1 point, according to the Papworth criteria (CVP > 12, PCWP > 12, MAP < 60, SVR > 1200, and CI < 2.4), and association with mortality was assessed based on cumulative scores. Cox proportional hazard models were used to describe the association between hemodynamics and post-transplantation survival.
Results: We identified 3416 patients who received cardiac allografts with pre-transplant invasive hemodynamics: 77% were male with a mean age of 52±12 years. Donor hemodynamics are shown (Table). The mean donor age was 34±12 years. CVP, PCWP, SVR, pulmonary artery (PA) diastolic pressure, PA systolic pressure, and CI were not associated with post-transplantation mortality when assessed as continuous variables. However, the top quintile of PCWP (>16 mmHg) was associated with increased post-transplantation mortality (Q5 vs Q1: HR 1.31 [1.02 – 1.67], P=0.03). Of the 1095 patients with complete sets of hemodynamic variables, 496 (45.3%) had 0, 295 (26.9%) had 1, and 214 (19.5%) had 2 unmet Papworth criteria (median number of unmet criteria was 1). There was no association between number of unmet Papworth criteria and mortality (p=0.61) (Figure).
Conclusions: In this large retrospective study, high PCWP was the only hemodynamic variable associated with post-transplant mortality.