Donor Pulmonary Status Impacts Survival in Cardiac Transplant Recipients

Purpose Cardiac preconditioning observed during ischemic and physiologic stress can enhance outcomes following subsequent myocardial injury. Transplantation provides obligate ischemia on a relatively healthy donor heart. Hearts are procured from donors from which the lungs may or may not be suitable for transplantation. We hypothesized that hearts exposed to lungs deemed to be unacceptable for lung transplant would be preconditioned and thereby have improved post-transplant survival compared to hearts retrieved from donors with both heart and lungs procured. Methods and Materials We examined adult cardiac transplant recipients within the United Network for Organ Sharing database from 1998-2012. Two groups were identified: lung donor = LD, non lung donor = NLD. Kaplan Meier unadjusted survival analysis and Cox proportional-hazards regression was performed. Results Of 51,546 patients who underwent cardiac transplantation, 29,601 (57.4%) were from a LD. At 30 days post-transplant, survival was not different between groups. However, at 1, 5 and 10 years, patients who received a heart from a LD had worse survival than from a NLD (unadjusted HR = 1.59, p figure 1 ] Conclusions Cardiac transplant recipients from donors with unsuitable lungs had similar survival, suggesting that acutely preconditioned hearts neither enhance nor worsen perioperative survival. The potential effects of preconditioning and other factors accounting for the marked difference in long-term survival remain to be determined.