Transplantation of Center for Disease Control “High-Risk” Donor Hearts Does Not Adversely Impact Long-Term Outcomes in Adults

•Growing orthotopic heart transplantation waitlist.•High-risk donor (HRD) organs are a potential donor source.•HRD status does not impact survival.

BackgroundThe “high-risk donor” (HRD) label was applied to donors who met the Centers for Disease Control and Prevention criteria for high-risk behavior in 2004. The number of potential recipients who die awaiting orthotopic heart transplantation (OHT) has increased. Despite organ shortages, HRD grafts are often declined given infectious concerns. We hypothesized that recipients would have equivalent outcomes.MethodsWe retrospectively analyzed the United Network of Organ Sharing adult heart transplant data from June 2004 to December 2013. OHT recipients were divided into 2 cohorts by donor status.ResultsDuring the study period, 37,408 OHTs were performed and 3196 (8.5%) patients received HRD grafts. Recipients of HRD were significantly older (P < .0001) and had a higher body mass index (P < .0001) compared with standard-risk donor recipients. No significant difference in waitlist time (P = .69) or blood type (P = .07) was noted. A higher number of HRD recipients were on mechanical circulatory support (35.6%) compared with standard-risk donor (33.3%, P = .009). Both grafts manifested similar, low rates of rejection before discharge (P = .88). One1 (84.3 vs 83%) and 5-year (71.2 vs 65.5%) survival was similar in the cohorts (log-rank P = .7571).ConclusionsHRD status does not significantly affect recipient outcomes after OHT. Increased use of HRD grafts could augment donor pool and decrease the mortality associated with long waitlist times.

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