Application Of Marginal Donor In Heart Transplantation

Background: For patients with end-stage heart disease,heart transplantation is the only treatment that can achieve good long-term and medium-term outcomes.The contradiction between the large number of patients and the shortage of donors is becoming increasingly acute.With the advancement of surgical methods,anti-rejection drugs,myocardial protection and cardiac assistant devices,some donor hearts with risk factors have been gradually applied to heart transplantation,such as donor age,low weight ratio of donor to recipient,inconsistent blood type of donor and recipient,and long cold ischemia time.Such donors are called marginal donors.The clinical application of such donors is still controversial.Therefore,the clinical application of marginal donors needs to be further explored.Methods: Marginal donor heart refers to donor heart with <0.8 body weight ratio of donor and recipient,age of donor heart > 50 years old,cold ischemia time > 6 hours,incompatibility with AB0 blood group,positive serological indicators of hepatitis virus,and not completely normal donor heart(combined with coronary artery disease,congenital heart disease,valvular disease or left ventricular hypertrophy).In this retrospective study,36 patients with end-stage heart disease who underwent orthotopic heart transplantation from 2014-01 to 2019-01 were divided into two groups according to the above marginal donors: marginal donors(10 cases)and conventional donors(26 cases).The clinical data of preoperative,intraoperative and follow-up stages were compared to analyze the effect of marginal donor heart transplantation.Results:(1)There were no significant differences in age,sex,preoperative cardiac function,LVEF value and pulmonary vascular resistance between marginal donors and conventional donors by comparing preoperative clinical data.(2)By comparing the perioperative data,it was found that there were no significant differences between the two groups in the time of cardiopulmonary bypass during operation,the time of auxiliary circulation,the time of mechanical ventilation after operation,the postoperative LVEF,the perioperative mortality,the incidence of heart failure and renal failure after operation.(3)Comparing the long-term follow-up data,no significant difference was found in heart failure and 1-year survival rate,but the incidence of renal insufficiency and lower respiratory tract infection was higher in marginal donors than in conventional donors.Conclusion: The results of this study show that,with the support of myocardial protective fluid,surgical methods,anti-rejection drugs and intensive care drugs,there is no significant difference between marginal donors and conventional donors in early and mid-term outcomes.Marginal donors do not affect the heart function and early survival rate of recipients after transplantation,and should not be considered as surgical contraindications.After rigorous evaluation of donor heart,marginal donor heart can be used in heart transplantation.