Surgical Palpation to Exclude Donor Transmitted Coronary Disease: A Single Centre Experience

Purpose The 2020 ISHLT consensus statement recommends coronary angiography in potential heart donors with risk factors for coronary disease (CAD), including those aged >40 yrs. Angiography is not commonly available for donors in the UK. At retrieval, donor hearts without palpable CAD are offered for transplantation. The accuracy of this in detecting underlying CAD is unreliable. We examined the incidence of occult donor transmitted (dt) CAD and its impact on long term survival in our heart transplant (HTx) recipients. Methods All adult patients undergoing HTx Jan’08 - Dec’18, who had early coronary angiography post HTx by left heart catheterization or computed tomography included. Angiograms were retrospectively graded by 2 observers, according to ISHLT classification of CAV. Significant dtCAD was defined as evidence of CAV grade 2 or 3 or a focal lesion >50% in a main artery at first angiographic assessment. Results Over the 11-year period 389 HTx performed, 302 met inclusion criteria. Mean recipient age 48.8 yrs, 77.8% male, donor age 38.2 yrs, 64.6% male, BMI 26.6 kg/m2. 28 recipients (9%) had evidence of dtCAD. This was associated with a significant reduction in long term survival (Figure 1, p=0.002). No significant difference in dtCAD in hearts from donors >40 yrs vs donors ≤ 40 yrs (10.3 % vs 8.3%, p=0.99). In donors >40 yrs, neither a history of smoking (p=0.18), diabetes (p=0.36) or hypertension (p=0.55) were associated with significant CAD in isolation. The presence of 2 or more of the aforementioned risk factors in those > 40 yrs was associated with a higher incidence of dtCAD (25.0% vs 8.0% p=0.05). Conclusion In this single centre cohort, dtCAD was associated with a reduction in long-term conditional survival following HTx. Donor age of >40 yrs alone was not predictive of significant dtCAD.Donor age >40 along with a history of 2 or more of hypertension, smoking or diabetes was found to be predictive of a higher risk of dtCAD. In such donors, surgical palpation alone may be insufficient to exclude significant CAD.