Frequent Use of Organs after Rescue Allocation for Heart Transplantation: Can We Still Achieve Adequate Results?

Purpose The number of patients on the heart waiting list in the ET-region is almost threefold higher than the number of patients who will actually undergo heart transplantation (htx). Consequently waiting times continue to increase and can be beyond a year even for high-urgent (HU)-listed patients. One possible solution for an increased donor pool is the acceptance of so-called marginal organs. This analysis deals with the effect of frequently using organs after rescue allocation for cardiac transplant in our department. Methods Between 10/2010 and 9/2018 115 patients underwent htx in our department. 65 of the 115 transplant recipients (56.5 %) were transplanted with HU-allocations (group HU), the remaining patients received organs after rescue allocation (gr. T). These organs had been rejected by at least 3 consecutive transplant centers due to medical reasons. Perioperative parameters of donor and recipient and posttransplant outcomes were compared between these 2 groups. Results Mean donor age was higher in group T (p 0.05). All other donor parameters (CMV status, time of ischemia as well as sex) were comparable between the groups. 30-day mortality was higher in HU-patients (12.3 %) compared to 10 % after rescue allocation, p>0.05. Primary graft dysfunction (PGD) with extracorporeal life support occurred in 33.8 % after HU-transplantation and in 18 % of gr. T (p 0.05). Conclusion Our data support the use of hearts after rescue allocation. Probably as a consequence of the impaired clinical status of HU-recipients, early mortality was lower in patients after receiving rescue organs. However, one-year survival was comparable again, indicating a yet remarkable mortality in those patients beyond the first postoperative month.