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Stroke-related brain death in young heart donors tied to higher recipient mortality

Journal of the American College of Cardiology
Reuters Health - 14/03/2022 - Stroke as a cause of death in young organ donors is linked with worse survival for heart transplant recipients, U.S. data show.

The same is not true when stroke was the cause of death for older donors, however, according to Dr. Takahisa Mikami of Tufts University School of Medicine in Boston and colleagues.

The researchers analyzed data from the United Network for Organ Sharing on 18,438 patients who received new hearts between 2005 and 2018, including 3,761 whose donors died of stroke.

Overall, they saw no difference in mortality risk between heart recipients whose donors did or did not die of stroke (adjusted HR,1.07,95% CI 0.096-1.19), according to a report in the Journal of the American College of Cardiology.

But when heart donors were age 40 or younger, stroke-related death was associated with higher five-year mortality (hazard ratio, 1.17; 95% CI: 1.02-1.35) and higher risk of graft failure during follow-up (HR, 1.30; 95% CI:1.04-1.63).

The association was most prominent in the first 60 days posttransplant and in recipients with higher pulmonary vascular resistance.

Younger donors who died of stroke had clinically similar hemodynamics compared with those who died of other causes, the researchers noted.

The increase in mortality and graft failure may be due to the fact that stroke in younger donors is more likely to have been hemorrhagic and may reflect an underlying vasculopathy, they suggest. Also, they note, younger donors in this study had longer predonation hospitalizations, which may have allowed for more unrecognized physiological insults.

In an editorial, Dr. Sunit-Preet Chaudhry of St Vincent Medical Group in Indianapolis and colleagues applaud the study for "its large size, use of multiple centers, the long term follow up and the robust methods."

They caution, however, that the results should not encourage cardiac transplant teams to refuse younger donors with strokes, as one-year survival in recipients of those donors' hearts was still nearly 90%.

Instead, the editorialists say, they hope this study will encourage interventions to modify factors that could lead to even better outcomes.

SOURCE: https://bit.ly/35PsNn6 and https://bit.ly/3COo7d1 Journal of the American College of Cardiology, online March 14, 2022.

By Reuters Staff

© 2023 The Author(s). Published by Medicom Medical Publishers.
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