Donor pulmonary hemodynamics does not impact recipient outcomes in adult heart transplantation

Purpose: The impact of donor pulmonary hemodynamics as assessed by mean pulmonary artery pressure (mPAP) and transpulmonary gradients (TPG) on the clinical outcome of heart transplant (HT) recipients is unknown. We compared outcomes of adult HT recipients as stratified by donor pulmonary hemodynamics in the contemporary era in the United States.

Methods: We reviewed adult donor hearts (age ≥ 18 years) which were offered for transplantation between January 2010 and March 2023 in the UNOS database with available right heart catheterization (RHC) data. Adjusted Cox regression was performed to evaluate the relationship between 30-day and 1-year mortality after HT and donor mPAP, TPG, and mean arterial pressure (MAP). Each hemodynamic parameter was modeled as a quadratic polynomial to not assume a linear relationship with mortality.

Results: 2038 HT recipients with complete donor RHC were included: 58 % were on inotrope support. Elevated mPAP (≥25 mmHg), TPG (≥15), and PVR (≥1.5) were present in 416 (20.4 %), 179 (8.8 %), and 2038 (100 %), respectively. No significant association was found between donor mean PAP (HR 1.47, 95 % CI 0.80-2.67), donor TPG (HR 0.47, 95 % CI 0.20-1.08), and donor PVR (HR 1.69, 95 % CI 0.77-3.72) and 30-day mortality. Similarly, no significant association was found between donor mPAP (HR 1.33, 95 % CI 0.90-1.95), donor TPG (HR 0.65, 95 % CI 0.37-1.12), and donor PVR (HR 1.38, 95 % CI 0.83-2.32) and 1-year mortality.

Conclusions: Donor pulmonary pressures did not impact post-heart transplant survival in adult recipients. Donors with abnormal pulmonary hemodynamics remain viable donor hearts for transplantation.