Hemodynamic follow-up of cardiac allografts from poisoned donors.
BACKGROUND
The current shortage of donor organs, combined with an increasing demand for cardiac allografts, means that extended donor criteria are becoming more and more accepted. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion; few data are currently available in the medical literature. We describe our experience with 19 orthotopic heart transplant recipients of organs from donors after acute intoxication with different agents.


METHODS
Between March 1989 and December 1997, 883 orthotopic heart transplantations were performed at our transplant unit. Within this group, we accepted donor hearts after ethanol intoxication (n=1), benzodiazepine (n=1), alkylphosphate (E 605) in combination with beta-blocker intoxication (n=1), carbon monoxide poisoning (n=5), digitalis (n=1), digitalis/glibenclamide (n=1), chlormethiazole (n=1), propoxyphene (n=1), alkylphosphate (E 605) (n=1), insulin (n=2), neprobamate/ thiocyacide/flurazepam (n=1), paracetamol (n=1), carbamazepine (n=1), and cyanide (n=1) intoxication. At the time of organ explantation, hemodynamic data were available from all patients.


RESULTS
Early mortality in this group was 11%; cumulative survival after 5 years was 74%.


CONCLUSIONS
Based on our limited experience, cardiac allografts from donors exposed to different kinds of poisons can be transplanted in selected cases. If the donor organ is not hemodynamically compromised, showing regular filling pressures on low or mild inotropic support just before explantation, and if there are no electrocardiographic changes in combination with elevation of the transaminases, cardiac allograft transplantation seems to be a safe and life-saving procedure.
Tenderich
G
G
Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Koerner
M M
MM
Posival
H
H
Arusoglu
L
L
Hornik
L
L
Mirow
N
N
Stuettgen
B
B
Wlost
S
S
Minami
K
K
Koerfer
R
R
D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000502:physiology* / Q000706:statistics & numerical data*; D006439:Hemodynamics; D006801:Humans; D011041:Poisoning / Q000097:blood*; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous