Improved long-term outcomes after heart transplantation utilizing donors with a traumatic mode of brain death

BackgroundThe donor's mode of brain death (BD), being associated with impairment of myocardial function and hemodynamic performance, impacts the prognosis of the heart transplantation (HTx) recipient.MethodsAll patients who underwent HTx between 1996 and 2017 were categorized according to donor's BD mechanism: traumatic BD (TBD) versus non-traumatic BD (NTBD).ResultsThe TBD group included 105 recipients, and the NTBD group, 85 recipients. Kaplan-Meier survival analysis showed that overall survival was significantly higher for recipients of TBD hearts (10-year survival 58.1 vs. 37.6%, p=0.044). Consistently, multivariate analysis showed that TBD was independently associated with a significant 43% reduction in mortality [95% confidence interval (CI) 0.42-0.75, p=0.033]. Rejection rate was lower in the TBD group (total rejection score 0.440.32 vs. 0.51 +/- 0.38, p=0.04; any rejection score 0.38 +/- 0.26 vs. 0.45 +/- 0.31, p=0.030), and freedom from cardiac allograft vasculopathy (CAV) was significantly higher in recipients of traumatic vs. non-traumatic donors (10years: 82.9 vs. 62.4%, log-rank p-value=0.024). Multivariate analysis showed a significant 42% reduction in CAV [hazard ratio (HR)=0.58, 95% CI 0.51-0.85, p=0.022).Conclusion Mode of brain death significantly impacts HTx outcomes, with TBD being associated with reduced mortality, rejections and CAV.