title: Decreased recipient survival following orthotopic heart transplantation with use of hearts from donors with projectile brain injury.
abstract: BACKGROUND
  Fatal gunshot injury to the brain can cause significant alterations in the neuroendocrine state and myocardial dysfunction. Therefore heart allografts from these donors may result in graft failure following orthotopic heart transplantation (OHTx). We evaluated whether receiving a heart from a donor who died from fatal gunshot wound to the brain independently affected the outcome of transplantation.
  
  
  METHODS
  A retrospective review of 113 consecutive patients undergoing OHTx at a university hospital from 1996 to 2002 was performed. Group 1 received hearts from donors with fatal gun shot brain injury (n = 17), and Group 2 received hearts from donors who died from other causes (n = 96).
  
  
  RESULTS
  Recipient age, gender, United Network for Organ Sharing (UNOS) status, indication for transplantation, and other co-morbid conditions were similar in both groups. Young male donors pre-dominated in Group 1, but other donor characteristics were not significantly different. The incidence of Grade 3A rejection was higher in Group 1 than Group 2 (35% vs 6.3%, p = 0.003), as was the incidence of post-operative infection (35% vs 7.2%, p = 0.004). Actuarial survival at 1 and 5 years was significantly lower in Group 1 than in Group 2 (81% and 74% vs 97% and 94%, respectively, p = 0.005). Multivariate logistic regression analysis also demonstrated that fatal gunshot brain injury, as cause of donor death, was a risk factor for recipient mortality (p = 0.01).
  
  
  CONCLUSIONS
  Receiving a heart from a donor with fatal gunshot brain injury is a significant risk factor for recipient mortality following OHTx. Cautious use of heart allograft from these donors, especially in low-risk recipients, may lead to improved outcome following heart transplantation.
authors.affiliation: Department of Cardiothoracic Surgery, Oregon Health and Science University, 3181 Sam Jackson Park Road, Portland, OR 97201, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.forename: Irving
authors.initials: I
authors.lastname: Shen
authors.forename: Matthew
authors.initials: M
authors.lastname: Slater
authors.forename: Kathy
authors.initials: K
authors.lastname: Crispell
authors.forename: Ben
authors.initials: B
authors.lastname: Chan
authors.forename: Pasala
authors.initials: P
authors.lastname: Ravichandran
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D020197:Head Injuries, Penetrating / Q000401:mortality*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009922:Oregon / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D014948:Wounds, Gunshot / Q000401:mortality