Hearts with improving LVSD can be safely transplanted

Donor hearts with left ventricular systolic dysfunction (LVSD) can be revived and transplanted as successfully as other hearts, according to a study in the Journal of the American College of Cardiology.

After reviewing transthoracic echocardiograms (TTEs) from nearly eight years of transplants in the United Network of Organ Sharing database, researchers identified 472 donor hearts with LVSD that resolved during donor management. These donors demonstrated a left ventricular ejection fraction (LVEF) of 40 percent or less on the initial TTE but later showed LVEF of at least 50 percent.

When compared against “normal” donors with LVEF of at least 55 percent on the initial TTE, no significant differences in mortality were detected at 30 days, one year, three years and five years of follow-up. There were no differences in cardiac allograft vasculopathy or primary graft failure, either.

“These results provide concrete evidence that donor hearts with LVSD on the initial echocardiogram, if appropriately managed, can be successfully resuscitated and have good short- and intermediate-term outcomes,” wrote the study’s authors, including lead researcher Shivank Madan, MD, of the division of cardiology at Albert Einstein College of Medicine in New York. “Considering that LVSD accounts for 25 percent to 30 percent of nonuse of donor hearts, the findings of this study should be encouraging and help to increase donor utilization rates.”

Madan also headed recent research showing hearts from early adolescent donors can be safely transplanted to adults. The combination of these findings could reduce the gap between organ need and availability.

In both studies, Madan and colleagues noted more than 20,000 patients in the United States may benefit from heart transplantation, yet only 2,000 to 2,400 receive one each year.

Young people in the setting of brain death, in particular, should be considered possible donors if LVEF improves on a subsequent echocardiogram, according to Madan et al.

“Our study strongly suggests that transplant centers should not reject potential donor hearts based on LVSD on a single TTE alone,” they wrote. “TTE should be repeated in such hearts after hormonal and hemodynamic optimization.”

Looking ahead, the researchers suggested studies evaluating 10-year outcomes of donor hearts with improved LVEF, and analysis of specific donor management practices, which were an unknown variable in their study.