Comparing Mortality in Heart Transplantation Utilizing Donor Hearts with and without CAD

Purpose We want to determine if there is a difference in outcomes in heart transplant (HTx) recipients who receive donor hearts with known coronary artery disease (CAD) versus those without CAD. Methods Using the United Network of Organ Sharing (UNOS) Organ Registry, we compared mortality rates for HTx recipients who received donor hearts without CAD versus those with CAD with a multivariate Cox proportional hazard regression model adjusting for age, sex, race, diabetes diagnosis, ischemic time, need for dialysis/life support, recipient wait-time, and HLA mismatch. CAD was defined as 1 or more epicardial coronary vessels with ≥ 50% stenosis. We excluded patients who were age Results There were a total of 45,236 unknown-CAD HTx recipients, 650 non-CAD HTx recipients and 79 CAD HTx recipients in the UNOS Organ Registry. Non-CAD HTx recipients were less likely to have had prior cardiac surgery (61.2% vs 77.2% respectively, p=0.005), more likely to receive a younger donor heart (45.0±8.4 years vs 48.0±6.9 years respectively, p=0.002), less likely to have a VAD at time of transplant (59.4% vs 78.5% respectively, p Conclusion The vast majority of HTx recipients in the UNOS Organ Registry have donor hearts with unknown CAD status. Of those HTx recipients with known CAD, their 10-year mortality is significantly higher compared to non-CAD HTx recipients. This increased mortality may be in part due to donor CAD but is more likely multifactorial.