LAUSR

Purpose Primary Graft Dysfunction (PGD) is one of the primary causes of 30 day mortality after heart transplantation. Optimal donor management is crucial to ensure effective organ procurement and favourable transplant outcomes. The prognostic impact of pre-donation inotropes use on PGD remains controversial, and its implication on organ preservation strategy and acceptance decision remains unclear. The purpose of this study is to investigate the relationship between donor heart inotrope dose and the incidence of PGD defined using the standard definition of PGD from the ISHLT consensus statement, and 30 day mortality post heart transplant. Methods Retrospective study of all patients who underwent isolated cardiac transplantation in a single centre between January 2017 and December 2019. Donor data was obtained de-identified from the Australian and New Zealand Cardiothoracic Organ transplant registry and electronic donor records (EDR). Inotropes were pooled into a vasoactive inotropic score (VIS). The primary outcome was a composite of PGD and 30 day mortality. Results There were 43 heart transplants and 40 were included for analysis. One patient was excluded as they underwent combined cardiac and kidney transplant, and there was incomplete donor data for 2 patients. 7 out of 40 patients (17.5%) developed primary graft dysfunction, and 4 patients (10%) died within 30 days of transplant. The primary composite endpoint occurred in 10 (25%) patients. Of the 7 patients that developed PGD, 1 died within 30 days. Patients were stratified into two groups according to their VIS (High versus Low). Multivariate logistic regression demonstrated that patients in the High VIS group (VIS> 26) had a higher incidence of the primary composite outcome occurring in 40% of patients when compared to the Low VIS group (VIS Conclusion Our single centre retrospective study demonstrated an increase risk of PGD and 30 day mortality associated with pre-donation high dose inotropes use. This preliminary finding suggests the potential utility of VIS to quantify pre-donation inotropes use and may inform donor organ management and acceptance decisions.