Effect of donor heart damage on survival after transplantation

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Abstract
Evaluation of the functional condition of the heart prior to its removalfrom the donor or after transport to the recipient is difficult. Biopsiesof the myocardium allow serial assessments to be made throughout thisperiod, but suffer from the disadvantage that the average analysis ofbiopsies has only a tenuous connection with physiological function.Quantitative birefringence measurements (QBM), on the other hand, assessthe ability of myocardial fibres to respond to ATP and calcium and havebeen shown to correlate well with measurements of cardiac function (P lessthan 0.001). A prospective study of myocardial biopsies before excision,after transport and again after transplantation, using quantitativebirefringence measurement of biopsies of the heart has recently beencompleted. These studies have shown evidence of impaired myocardialfunction in 73 (43%) of 172 donor hearts studied prior to excision, with afurther 27% showing significant deterioration during storage and transportto the recipient. Biopsy assessments therefore indicated that at the momentof implantation, only 30% of the donor hearts were normal. Functionalassessment of the biopsies by QBM correlated with early clinical outcome oftransplantation (P less than 0.001). Longer term follow-up of therecipients (up to 5 years) has shown that the mortality of recipients ofhearts with impaired function before transplantation is significantlyincreased (44% of 120) compared with that of recipients of undamaged hearts(6% of 52, P less than 0.001).

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