title: Medium-term outcome of recipients of marginal donor hearts selected with new stress-echocardiographic techniques over standard criteria.
abstract: BACKGROUND
  Heart transplantation is limited by severe donor organ shortage. Regardless of the changes made in the acceptance of marginal donors, any such mechanism cannot be considered successful unless recipient graft survival rates remain acceptable. A stress echo-driven selection of donors has proven successful in older donors with normal left ventricular resting function and in standard donors with reversible resting left ventricular dysfunction acutely improving during stress, or slowly improving (over hours) during intensive hormonal treatment. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected with new echocardiographic techniques over standard criteria.
  
  
  RESULTS
  We enrolled 43 recipients of marginal donor hearts: age > 55 years, or < 55 years but with concomitant risk factors, n = 32; acutely improving during stress, n = 3; or slowly improving during hormonal treatment, n = 8. At follow-up (median, 30 months; interquartile range, 21-52 months), 37 of the recipients were still alive. One-year survival was 93%.
  
  
  CONCLUSIONS
  The strict use of new stress-echocardiographic techniques over standard criteria of marginal donor management, together with comprehensive monitoring of the donor, has the potential to substantially increase the number of donor hearts without adverse effects on recipient medium-term outcome.
authors.affiliation: Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy. bombardini@ifc.cnr.it.
authors.forename: Tonino
authors.initials: T
authors.lastname: Bombardini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arpesella
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.forename: Francesco
authors.initials: F
authors.lastname: Procaccio
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Sonia
authors.initials: S
authors.lastname: Bernazzali
authors.forename: Ornella
authors.initials: O
authors.lastname: Leone
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*