The donor heart must to be of high quality with less myocardial damage and highly viable cells at implant. In this study we report the intermediate term outcomes of patients who received hearts from donors stratified by serum levels of troponin-T (Tn-T, ng/ml) as an index of myocardial damage preoperatively.
Cardiac transplant recipients were divided into groups based on donor blood Tn-T levels ( I: 0.48 ±0.1, n=7; II: 3.84±0.6, n=11; III: 6.78±0.8, n=4). Rejections were identified in endomyocardial biopsies done every 2-3 months for 1 year after the surgery and yearly thereafter. Data regarding intermediate outcomes and hospital encounters of the recipients were obtained from medical records.
The majority of hearts (90%) came from donors with head trauma. Recipients underwent orthotopic heart transplantation for idiopathic dilated or ischemic cardiomyopathy. At a mean interval of 32.7±8.4 days post-transplantation, group I had 0, group II had 4.72 ±1 Grade 1, and group III had 4±2 rejections of Grade 3A. At the time of their most recent follow-up (mean 6.2 ±1.2 years), the rejection episodes were given in the tableGroupMean # Biopsies(±SD)Negative1A/B23I19 ± 560%40%II16 ± 351%49%III23 ± 239%38%13%10%. Rejection episodes of Grade 3 necessitated increased doses of immunosuppressant therapy that was associated with reduced bone density. At last follow up, the LVEF and RV dimensions are normal in all recipients and do not significantly differ between the groups. The serum creatinine levels averaged 1.4±0.8. One patient died 4 years after transplantation due to cardiomegaly with mild biventricular hypertrophy and dilatation. All other patients exhibit normal cardiac function.
The quality of donor hearts as measured by Tn-T levels predicts the frequency and severity of rejection episodes following transplantation. This does not appear to affect long-term cardiac function, but treatment for rejection episodes may affect bone density and thus quality of life.
The assessment of donor heart before transplantation is critical and the condition of myocardium relates to future rejection episodes.
P. Vijay, None.