Use of potentially infected donor hearts for cardiac transplantation.
Despite the nationwide shortage of heart donors, more patients, some of whom are critically ill, are being accepted as candidates for transplantation. Thus, on occasion, we have liberalized our donor criteria to meet the demand. We have recently transplanted 16 potentially infected donor hearts into critically ill recipients. Of these 16 donors, 7 had multiple positive blood cultures as follows: Streptococcus pneumoniae (3), Staphylococcus aureus (2), Klebsiella pneumoniae (1), and Enterobacter sp (1). Seven other donors were accepted despite high fevers (rectal temperature greater than 38.9 degrees C), leukocytosis (greater than 18 x 10(9)/L [greater than 18,000 cells/microL]), and pulmonary infiltrates with positive sputa (Enterobacter [3], Klebsiella pneumoniae [2], and Staphylococcus [2]). Two other donors with hepatitis B surface antigen positivity were deemed at high risk but were used because the recipients were in immediate need. Early mortality (less than or equal to 30 days) among the recipients was 3/16 (18.7%) with 1 patient dying of uncontrolled allograft rejection, 1 of hepatic failure, and 1 of Pseudomonas septicemia. Late mortality (greater than 30 days after operation) occurred in 6 patients: 2 patients died of hepatic failure, 3 died of graft atherosclerosis, and 1 died of iatrogenic hemorrhage after a liver biopsy. Only 1 patient died of infection unrelated to that of the donor, and the other patients had no infectious complications resulting from the organisms identified in their respective donors. Use of potentially infected donor hearts resulted in surprisingly few infectious complications in this group of recipients. This practice can be safe and should be considered when other options are unavailable.
Lammermeier
D E
DE
Division of Cardiovascular Surgery, Texas Heart Institute, Houston.
Sweeney
M S
MS
Haupt
H E
HE
Radovancevic
B
B
Duncan
J M
JM
Frazier
O H
OH
D000328:Adult; D001424:Bacterial Infections / Q000635:transmission*; D003586:Cytomegalovirus Infections / Q000635:transmission; D005260:Female; D006679:HIV Seropositivity; D016027:Heart Transplantation / Q000401:mortality; D006509:Hepatitis B / Q000635:transmission*; D006801:Humans; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014123:Toxoplasmosis / Q000635:transmission