Temporal changes in left ventricular systolic function in heart donors: results of serial echocardiography.
BACKGROUND
Heart donor availability continues to limit cardiac transplantation rates and many donor hearts are not transplanted because of left ventricular dysfunction. The aim of this study was to determine whether intensive donor management results in improved left ventricular systolic function as measured by serial echocardiography.


METHODS
Using the California Transplant Donor Network Database, all donors who underwent serial echocardiography during donor management (from 1996 to 2000) were identified. The study includes those donors with ejection fractions <50% or regional wall-motion abnormalities shown on the initial echocardiogram. The database provides clinical data describing donor characteristics, treatments, and recipient outcomes. The mean ejection fractions at the first and second echocardiograms were compared using the Wilcoxon signed rank test.


RESULTS
In 13 of 16 subjects, initial ejection fractions were <50% and improved in 12 subjects after intensive donor management. Seventy-five percent of the donors received high-dose corticosteroids, 15 of 16 received dopamine, and none received thyroid hormone. In 12 subjects, the donor hearts were transplanted with a survival rate of 92% at an average follow-up of 16 months.


CONCLUSIONS
This pilot study indicates that in some cases, intensive donor management is associated with improved donor left ventricular function. Prospective studies are indicated to determine the predictors of improved donor left ventricular dysfunction and of recipient survival when sub-optimal hearts are transplanted.
Zaroff
Jonathan G
JG
Department of Medicine, University of California, San Francisco, California 94143-0124, USA. zaroff@medicine.ucsf.edu
Babcock
Wayne D
WD
Shiboski
Stephen C
SC
Solinger
Lisa L
LL
Rosengard
Bruce R
BR
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D000075202:Contraindications; D004298:Dopamine / Q000627:therapeutic use*; D004452:Echocardiography; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology*; D016027:Heart Transplantation / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D013599:Systole / Q000187:drug effects / Q000502:physiology*; D013963:Thyroid Hormones / Q000627:therapeutic use*; D013997:Time Factors; D014019:Tissue Donors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D002316:Cardiotonic Agents; D013963:Thyroid Hormones; D004298:Dopamine; D008775:Methylprednisolone