Cardiac transplantation can be safely performed using selected diabetic donors

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 146; no. 2; pp. 442 - 447
• Main Authors: Taghavi, Sharven, MD, MPH, Jayarajan, Senthil N., MD, Wilson, Lynn M., RN, Komaroff, Eugene, PhD, Testani, Jeffrey M., MD, MTR, Mangi, Abeel A., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-08-2013
• Subjects: Adult; Cardiothoracic Surgery; Chi-Square Distribution; Diabetes Mellitus - diagnosis; Diabetes Mellitus - drug therapy; Diabetes Mellitus - mortality; Donor Selection; Female; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Tissue and Organ Procurement; Tissue Donors - supply & distribution; Treatment Outcome; United States; United States; ECMO; 34; United Network for Organ Sharing; body mass index; CI; hazard ratio; confidence interval; extracorporeal membrane oxygenation; HR; UNOS; BMI
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.02.047

Objective Cardiac transplantation (OHT) using diabetic donors (DDs) is thought to adversely influence survival. We attempt to determine if adult OHT can be safely performed using selected DDs. Methods The United Network for Organ Sharing (UNOS) database was examined for adult OHT from 2000 to 2010. Results Of the 20,348 patients undergoing OHT, 496 (2.4%) were with DDs. DDs were older (39.6 vs 31.3 years; P  < .001), more likely female (41.5% vs 28.3%; P  < .001), and had a higher body mass index (BMI) (29.9 vs 26.4; P  < .001). Recipients of DD hearts were older (53.4 vs 51.8; P  = .004) and more likely to have diabetes (18.9% vs 14.9%; P  = .024). The 2 groups were evenly matched with regard to recipient male gender (78.0% vs 76.1%; P  = .312), ischemic time (3.3 vs 3.2 hours; P  = .191), human leukocyte antigen mismatches (4.7 vs 4.6; P  = .483), and requirement of extracorporeal membrane oxygenation (ECMO) as a bridge to transplant (0.8% vs 0.5%; P  = .382). Median survival was similar (3799 vs 3798 days; P  = .172). On multivariate analysis, DD was not associated with mortality (hazard ratio [HR], 1.155; 95% confidence interval [CI], 0.943-1.415; P  = .164). As previously demonstrated, donor age, decreasing donor BMI, ischemic time, recipient creatinine, recipient black race, recipient diabetes, race mismatch, and mechanical ventilation or ECMO as a bridge to transplant were associated with mortality. On multivariate analysis of subgroups, neither insulin-dependent diabetes (1.173; 95% CI, 0.884-1.444; P  = .268) nor duration of diabetes for more than 5 years (HR, 1.239; 95% CI, 0.914-1.016; P  = .167) was associated with mortality. Conclusions OHT can be safely performed using selected DDs. Consensus criteria for acceptable cardiac donors can likely be revised to include selected DDs.