High Prevalence of Warfarin Genotype Polymorphisms in Patients with Mechanical Circulatory Support

Purpose: We report a retrospective study of UNOS data on the value of hormonal therapy (HT) on procurement/transplantation (Tx) of hearts and lungs from 63,593 donors. The study extended from 2000-2009, and included 37,263 males (59%, 38y) and 26,330 females (41%, 43y). HT consisted of combinations of thyroid hormone (T3 or T4) +/anti-diuretic hormone (ADH) +/corticosteroids (C) +/insulin (I). Methods: T3/T4 had been administered to 30,962 donors (49%) but not to 32,631 (51%), but information on other hormones, e.g., ADH, C, or I, was lacking in > 20,000 cases. In a subgroup of 40,124 donors, information on all four hormones was recorded; 23,022 (Group A 57%) had received T3/T4 +/other HT, and 17,102 (Group B 43%) had received other HT but not T3/T4. Groups A and B could each be divided into 8 subgroups depending on the HT received. Data analysis was performed using SAS V9.3. Two metrics were calculated to evaluate the effect of HT on organ procurement. A multivariate analysis was carried out based on 40,124 donors (Groups A + B) to determine whether age, gender, race, cause of death, BMI, OPO region, or other HT (non-T3/T4) influenced procurement. Post-Tx recipient survival was determined at 1m and 1y based on 63,593 donors. Results: In 63,593 donors, treatment with T3/T4 resulted in procurement rates of 37% (hearts) and 17% (lungs), whereas only 30% (hearts) and 12% (lungs) were procured from donors not treated with T3/T4, an increase of 7% (hearts) and 5% (lungs) (both p< 0.0001). In Group A, the procurement rates were 35% (hearts) and 18% (lungs) whereas in Group B the rates were only 26% (hearts) and 13% (lungs), increases of 9% (hearts) and 5% (lungs) (both p< 0.0001). More hearts (p< 0.0001) and lungs (p< 0.025) were procured in every single subgroup of Group A than of Group B, except one. Multivariate analysis indicated a beneficial effect of T3/T4 on heart or lung procurement independent of other parameters (p< 0.0001). After Tx, based on 63,593 donors, there was increased survival of recipients who had received hearts from T3/T4-treated donors at 1m (95vs94%) and 1y (89vs87%) (both p< 0.05). Recipients of lungs had increased survival at 1m (96vs95%) (p< 0.05), with a trend to increased survival at 1y (85vs83%) (p= 0.0522). Conclusion: T3/T4 therapy is associated with procurement of significantly greater numbers of hearts and lungs, without detrimental impact on recipient survival.