Does Donor Cardiopulmonary Resuscitation Time Affect Heart Transplantation Outcomes and Survival?

Background: Donor heart availability has limited the number of heart transplants performed in the United States, while the number of patients waiting for a transplant continues to increase. Optimizing the use of all available donor hearts is important to reduce waiting list deaths and to increase the number of patients who can ultimately undergo a successful heart transplant. Donor cardiopulmonary resuscitation (CPR) time has been proposed to be a selection criterion to consider in donor selection. This study examined whether the duration of donor CPR time affects recipient posttransplantation outcomes and survival.

Methods: The United Network of Organ Sharing database was retrospectively queried from January 2005 to December 2013 to identify adult patients who underwent heart transplantation. This population was divided into four groups: donors with no CPR, CPR of less than 20 minutes, CPR of 20 to 30 minutes, and CPR exceeding 30 minutes. Kaplan-Meier analysis was used to compare the recipient posttransplant survival between groups, and posttransplant outcomes were examined. Propensity matching was performed for comparison of posttransplant survival of recipients of donors who did and did not undergo CPR. Multivariable logistic regression analysis was performed to examine individual independent variables for death after transplant.

Results: During this period, 17,022 patients underwent heart transplantation. Of those, 16,042 patients received hearts from a donor with no CPR, 639 patients with donor CPR of less than 20 minutes, 154 patients with donor CPR 20 to 30 minutes, and 187 patients with donor CPR exceeding 30 minutes. The posttransplant survival at 1 year for each group was 89% vs 90% vs 88% vs 89% and at 5 years was 75% vs 74% vs 74% vs 72%, respectively, which was not significantly different among the groups. Recipient primary graft failure and rejection rates were similar among the groups. The multivariable regression model showed CPR duration was not an independent risk factor for posttransplant death.

Conclusions: Donor CPR does not significantly affect outcomes and survival after transplant. In an effort to optimize donor heart use, donor CPR time alone should not be used to rule out the acceptance of a potential donor heart.