Donor Heart at Increased Disease Risk is Better Than Disease-free Heart

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Highlights:

• Transplantation with donor hearts at increased risk of disease can lead to better survival rates in transplant recipients
• A survival rate of 92.1% was observed in the transplant recipients even after 1 year and these benefits were maintained for up to 5 years
• Transplantation using donor hearts at increased disease risk can prevent many deaths, especially in patients on the waitlist for a heart transplant

Heart transplant patients on the waitlist could benefit from donor hearts that are at an increased risk of disease transmission, a new study suggests. Accepting a donor's heart that is at a higher risk of transmitting diseases is better than waiting for a disease-free heart.

The study, published in the Journal of the American College of Cardiology, indicates that if these wait-listed patients opt for the surgery, rather than waiting for a disease-free heart, they will have a higher one-year survival rate. For many patients, the benefits of opting for the surgery will far outweigh the low risk of disease of a healthy heart transplant. Importantly, this could reduce the number of potential deaths that may occur during the waiting period.

‘Taking donor hearts at increased risk of disease can prolong survival of the transplant recipients. Survival rates of over 92% can be seen even 1 year after the transplant. This survival rate can be maintained up to 5 years.’

Increased risk donors are those who can potentially transmit infections to the transplant recipient, such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus, and Hepatitis C Virus. These increased risk donors accounted for 19.5% of the total number of available donors, as per data from 2015.

Dr. Michael S. Mulvihill, MD, a House Staff in the General Surgery Residency Program at Duke University School of Medicine, USA, said: "For patients with end-stage heart failure, heart transplantation is not only the gold-standard of care but an increasingly-utilized therapy by clinicians treating these patients." He added: "Through this study, we discovered that acceptance of an increased risk donor heart offer has a significant survival benefit that should be part of the shared decision-making process for clinicians and patients."

Study Procedure

This was a retrospective study in which researchers examined the patient registry for heart transplant patients. The analysis involved a comparison between patients who opted for a heart transplant from an at-risk donor and those who refused to undergo transplantation. Data was accessed from the United Network for Organ Sharing (UNOS), a non-profit scientific and educational organization located in Richmond, Virginia, USA.

Between 2007-2017, a total of 2,602 increased risk donor hearts were offered to 10,851 patients awaiting heart transplantation. Those patients who declined to undergo the increased risk heart transplantation were followed-up for 1 year to see the outcome, indicated below:

• Increased donor risk or non-increased donor risk
• Death or decompensation
• Still remaining on the waitlist

These patients were compared with those who accepted the increased risk donor heart and went ahead with the transplantation. This comparison helped to determine the survival advantage of transplanting an increased risk donor heart.

Dr. Mulvihill said: "It's important to understand that patients who turn down an increased risk donor heart don't immediately get offered another, non-increased risk donor heart." "These patients are returned to the waitlist for an uncertain amount of time. We wanted to measure the risks of competing outcomes for these patients compared to patients who accepted the increased risk donor heart," he added.

Study Findings

Outcomes in patients who declined the increased risk donor heart:

• 58% underwent a non-increased risk donor heart transplant
• 12.4% underwent an increased risk heart transplant at a later stage
• 7.9% couldn't undergo transplantation either due to death or decompensation
• 21.1% were still on the waitlist even after 1 year

Outcomes in patients who accepted the increased risk donor heart:

• 92.1% survival rates were observed, even after 1 year, which persisted for 5 years

Advantages of the Study

• Transplantation of increased risk donor hearts have the potential to reduce the number of deaths of patients while on the waitlist
• In this regard, the patients need to be informed about the risks and benefits of increased risk donor transplants

Limitations of the Study

• Statistical analysis could be biased due to unmeasured confounders such as the reason behind why patients refused to accept the increased risk donor hearts
• The rate of disease transmission after transplantation could not be analyzed from the available data

Reference:

1. Decline of Increased Risk Donor Offers on Waitlist Survival in Heart Transplantation - (http://www.onlinejacc.org/content/72/19/2408)

Source: Medindia

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