Clinical Factors Associated with Left Ventricular Recovery in Brain Dead Cardiac Donors

Abstract

Purpose Donor left ventricular (LV) dysfunction remains a primary reason donor hearts are not utilized for transplant. Transient ventricular dysfunction often occurs after brain death, and recent work has shown that use of these donors may not be associated with poorer post-transplant outcomes. In order to identify the clinical factors associated with LV recovery in potential heart donors, we reviewed our experience using protocolized management of donors at an off-site organ diagnostic and recovery center at a single OPO. Methods Clinical data were obtained for all potential donors evaluated between 2012-2017. LV dysfunction was defined as an ejection fraction (LVEF) of ≤ 40% on the initial echocardiogram. LV recovery was defined as an LVEF ≥ 50% before procurement. Out of 815 donors, 176 had initial LV dysfunction. Of these, 113 had ≥2 echocardiograms performed. Non-recovered and recovered groups were compared using chi-square tests and Student s t-tests. Results Of the 113 donors analyzed, 43% did not recover (N=49) while 57% recovered (N=64). Those who recovered from LV dysfunction were more likely to be male, younger, receive pRBCs, and have longer OPO management time. Recovery was not associated with cause of death, BMI, or CPR performed before arrival. Those who recovered had a lower peak troponin I (2.78 vs 24.5 ng/mL, p\u202f=\u202f0.035), but no significant difference was found regarding peak lactate, creatinine, or transaminases. At the time of the initial echocardiogram, there was no significant difference between vasoactive inotropic score (VIS) and norepinephrine dose between groups. However, at the time of the final echocardiogram, the recovery group had a lower VIS and norepinephrine dose. Conclusion Recovery of LV function is common after brain death. Several clinical factors are associated with LV recovery in potential heart donors and may be important in predicting LV recovery, extending donor management efforts, and ultimately increasing the number of hearts utilized for transplant.