Background

Orthotopic heart transplantation (OHT) is the gold standard for the management of select patients with end-stage heart failure, but limited by an ongoing organ donor shortage. Organs are sometimes allocated from outside British Columbia (BC), although these may be perceived as less desirable. We sought to compare survival after OHT by donors originating from BC, other Canadian provinces (Canada), and the United Network for Organ Sharing (USA).

Methods

This is a retrospective cohort analysis of all patients who underwent OHT between December 1, 1988 and October 21, 2014 through the BC Heart Transplant Program. Patients who were re-transplanted or for whom data was missing were excluded. Overall survival and survival stratified by donor origin at 10-years was determined. A multivariate analysis was performed to control for recipient age, donor age, and cold ischemic time.

Results

Over the study period, a total of 406 patients were transplanted, 24 of whom were re-transplanted or had missing data. Of the remaining 382 patients, 297 (77.7%) of recipients and 238 (62.3%) of donors were male. The median recipient age was 54.6 (IQR 46.0 – 61.0) years and the median donor age was 33 (IQR 22.0 – 46.0) years. Donors originated from BC, Canada, and USA in 281, 53, and 48 of cases, respectively. Overall survival at 10 years was 62.1%, 95% CI [56.3%, 67.4%]. There was no significant difference in 10-year survival (Figure 1) when comparing donors from BC (62.0%, 95% CI [55.4, 68.0]), Canada (63.2%, 95% CI [46.2, 76.2]), and USA (57.3%, 95% CI [32.4, 75.9]). There was a significant difference in median cold ischemic time between donors from BC (168 [IQR 107.5 – 228.0] minutes), Canada (243 [IQR 204.5 – 291.0] minutes), and USA (244 [IQR 217.3 – 278.8] minutes). After multivariable analysis, donor location was not predictive of poorer survival.

Conclusion

In this study, donor origin did not significantly impact 10-year survival after OHT despite a significant difference in cold ischemic times. These results suggest that foreign donors result in similar outcomes in BC.

CITATION INFORMATION: Kiamanesh O, Khosla A, Imai C, Johansson E, Virani S, Davis M, Cheung A, Bashir J, Munt B, Ignaszewski A, Kaan A, Toma M. The Impact of Donor Origin on Survival after Orthotopic Heart Transplantation. Am J Transplant. 2016;16 (suppl 3).

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