Cardiology · Surgery ·
Donor coronary angiography linked to higher heart transplant utilization in older donors
A Eurotransplant observational study analysed 20,681 donor heart offers from 2004 to 2020. Angiography findings were associated with lower rejection of hearts with normal results, while a model estimated greater utilization if angiography were more widely available for donors older than 40.
- Angiography was performed in 23.5% of donor heart offers.
- Normal angiograms were associated with lower odds of rejection.
- Broader angiography availability was linked to modelled utilization gains.
- The estimated 535 additional transplants are counterfactual, not observed.
Researchers analysed 20,681 donor heart offers reported to Eurotransplant between 2004 and 2020 to assess coronary angiography (CA), donor characteristics and acceptance. CA was performed in 23.5% of offers, mainly for older donors and those with cardiovascular risk factors. For donors without angiography, coronary artery disease (CAD) status was imputed using logistic regression based on clinical risk factors; the investigators also modelled transplant probabilities under a scenario of broader CA availability.
Among donors who underwent CA, 37.5% had CAD. CAD was associated with older age, male sex, hypertension and smoking. Hearts with normal CA findings had lower odds of rejection than hearts from donors without CA (odds ratio 0.36; P<.0001). In the counterfactual model, broader CA availability for donors older than 40 was associated with estimated utilization rising from 56.4% to 67.1%, equivalent to about 535 additional transplants.
The findings suggest angiographic information may reduce uncertainty in assessing older donor hearts, but they do not establish that expanding CA would cause more transplants. The utilization estimate is model-based, and CAD status was imputed for donors without angiography. The authors support a risk-adapted, resource-sensitive approach rather than routine angiography for all donors.
In practice
For teams assessing donor hearts, the findings suggest that coronary angiography may provide useful information, particularly for older donors: normal findings were associated with lower odds of rejection than no angiography. However, the estimated increase in utilization among donors older than 40 came from a counterfactual model, not an observed change in transplantation, and CAD status was imputed when angiography was unavailable. The study therefore supports considering angiographic information within risk-adapted donor assessment, but does not establish that broader testing will increase transplants.
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European Heart Journal: Coronary angiography in heart transplants from donors older than 40: a Eurotransplant study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.