Coronary Angiography of Potential Cardiac Donors Increases Cardiac Transplantation Rates

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Abstract

Purpose

Donor age has increased dramatically in Europe. Preexisting coronary artery disease (CAD) and its associated complications like primary graft failure and allograft vasculopathy are major concerns in older donors. Donor coronary angiography (DCA) can detect CAD but is not regularly used in all donors. The aim of this study was to analyze whether donor angiography has an impact on heart transplantation rates.

Methods

Between 2004 and 2016 all donor heart offers registered by Eurotransplant were analyzed for DCA use and transplantation rates. DCA rates were calculated and compared corrected for various donor risk variables: age, sex, diabetes (DM), hypertension (HT), smoking history (SH) and body mass index >30 (BMI). Influence of donor risk factors on DCA results was analyzed. The likelihood of transplantation of donors with and without DCA was compared in the overall donor population as well as within risk groups. Multiple logistic regression models were created to analyze the impact of donor risk factors on DCA rates, outcome and transplantation rates. P-value of <0.05 was defined as statistically significant.

Results

A total of 12 565 donor hearts were offered during the study period. In 2319 (18.5%), DCA’s were performed. 107 DCA’s were excluded due to unclear results. Median donor age was 45 (31-53) years, 54.4% were male. 3.4% of donors had DM, 20.5% HT, 44.4% SH and 10.0% had a BMI≥30. Donor risk variables had a significant impact on DCA use: age (10 year increments (10a): p<0.0001, OR:2.88), DM (p<0.0001,OR:1.81), HT (p<0.0001,OR:1.35), SH (p<0.0001,OR:1.86), BMI (p=0.01,OR:1.24), male (p=0.0002,OR:1.24). CAD was associated with donor age (10a: p<0.0001,OR:1.55), HT (p=0.0006,OR:1.43), SH (p<0.0001,OR: 1.9), male (p<0.0001,OR:2.25). Transplant rates were significantly higher in donors with normal DCA result (compared to no DCA performed: p<0.0001,OR:2.61), whereas other independent risk factors for transplantation were: age (10a: p<0.0001, OR 0.78), DM (p=0.0019,OR:0.69), HT (p=0.002,OR:0.84), male (p<0.0001,OR:0.74) and CAD detected by DCA (p<0.0001,OR: 0.83).

Conclusion

DCA is used more often in donors with CAD risk factors and donor CAD is associated with known risk factors. Normal DCA results are associated with higher transplantation rates independent of CAD risk factors. Thus, increasing utilization of DCA, in particular in donors at high CAD risk, might increase cardiac transplantation rates.

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