Evidence Based Evaluation and Acceptance of Donor Hearts for Transplantation

Heart Transplantation Clinical Trial

— DHS  

Official title:

Evidence Based Evaluation and Acceptance of Donor Hearts for Transplantation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02376387
• Other study ID #: NIH 41169
• Status: Completed
• Start date: March 2015
• Est. completion date: May 26, 2020

Study information

• Verified date: October 2021
• Source: Stanford University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

The proposed research will provide evidence-based strategies for the evaluation and acceptance of donor hearts for transplantation. This is relevant to public health because judicious expansion of donor hearts used for transplantation will make this life-saving procedure available to a larger number of patients living with end-stage heart disease.

Description:

The demand for donor hearts for transplantation far outstrips the supply; however, only one in three available cardiac grafts are used for transplantation. There are many reasons for graft non-use, but previous studies have failed to demonstrate consistent associations between donor characteristics, donor cardiac function, and adverse recipient outcomes. Thus, there is a critical need to standardize how cardiac allografts are evaluated and accepted for transplantation. The investigators long-term goal is to safely expand the use of available cardiac allografts without adversely affecting transplant recipient outcomes. The investigators propose to carefully characterize the current population of cardiac organ donors, particularly with regards to allograft function; to examine how decisions are made regarding graft acceptance for transplantation; and to systematically evaluate associations between donor characteristics and recipient outcomes. The investigators central hypothesis is that acceptable allografts for heart transplantation are being unnecessarily discarded, and the establishment of an evidence-based process for cardiac donor evaluation and acceptance will increase graft utilization rates while maintaining excellent clinical outcomes. In response to this need, the investigators propose a collaborative study with seven organ procurement organizations representing geographically diverse regions of the United States, to address the following specific aims: (1) To identify clinical correlates of graft function in potential donors being evaluated for heart transplantation. An existing online donor research database will be expanded for standardized collection of data on detailed donor characteristics, especially as pertains to cardiac allograft function. The investigators will perform expert core review of donor echocardiograms, including serial echocardiograms in donors with cardiac allograft dysfunction. Serial electrocardiograms and cardiac biomarkers (Troponin I and B-type natriuretic peptide) will also be studied; (2) To prospectively study reasons for cardiac allograft non-utilization for heart transplantation. Real-time data will be collected on specific reasons for allograft non-acceptance for transplantation in order to study graft acceptance practices and variation in graft utilization nationwide; and (3) To prospectively study associations between donor characteristics and recipient outcomes after heart transplantation. Data will be collected on recipient post-transplant length of hospitalization and survival to identify associations between donor predictors and recipient outcomes. This proposal is innovative because it focuses on an entirely different approach to donor-based research, thereby surmounting the limitations of prior investigations. Completion of the proposed study will have a positive impact by defining how to optimize the evaluation and use of available grafts for heart transplantation, thereby safely expanding the donor pool and increasing the number of heart transplants performed nationwide.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 4333
• Est. completion date: May 26, 2020
• Est. primary completion date: May 26, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

1. Brain dead (beating heart)

2. 18-65 years of age

3. HIV (-)

4. Donors authorized for research

Exclusion Criteria:

1. Donors not authorized for research

2. HIV (+)

Related Conditions & MeSH terms

• Heart Transplantation

Locations

Country	Name	City	State
United States	Gift of Life	Ann Arbor	Michigan
United States	LifeGift	Houston	Texas
United States	Gift of Hope	Itasca	Illinois
United States	LifeLink	Norcross	Georgia
United States	California Transplant Donor Network	Oakland	California
United States	Donor Network of Arizona	Phoenix	Arizona
United States	Oregon Health and Science University	Portland	Oregon
United States	Kaiser Permanente	San Francisco	California
United States	Stanford University	Stanford	California
United States	New England Organ Bank	Waltham	Massachusetts

Sponsors (11)

Lead Sponsor	Collaborator
Stanford University	California Transplant Donor Network, Donor Network of Arizona, Gift of Hope, Gift of Life, Kaiser Permanente, Life Gift Organ Donation, LifeLink, National Institutes of Health (NIH), New England Organ Bank, Oregon Health and Science University

Country where clinical trial is conducted

United States, 

References & Publications (10)

Chen JM, Sinha P, Rajasinghe HA, Suratwala SJ, McCue JD, McCarty MJ, Caliste X, Hauff HM, John R, Edwards NM. Do donor characteristics really matter? Short- and long-term impact of donor characteristics on recipient survival, 1995-1999. J Heart Lung Transplant. 2002 May;21(5):608-10. — View Citation

De La Zerda DJ, Cohen O, Beygui RE, Kobashigawa J, Hekmat D, Laks H. Alcohol use in donors is a protective factor on recipients' outcome after heart transplantation. Transplantation. 2007 May 15;83(9):1214-8. — View Citation

Khush KK, Menza R, Nguyen J, Zaroff JG, Goldstein BA. Donor predictors of allograft use and recipient outcomes after heart transplantation. Circ Heart Fail. 2013 Mar;6(2):300-9. doi: 10.1161/CIRCHEARTFAILURE.112.000165. Epub 2013 Feb 7. — View Citation

Lima B, Rajagopal K, Petersen RP, Shah AS, Soule B, Felker GM, Rogers JG, Lodge AJ, Milano CA. Marginal cardiac allografts do not have increased primary graft dysfunction in alternate list transplantation. Circulation. 2006 Jul 4;114(1 Suppl):I27-32. — View Citation

Nixon JL, Kfoury AG, Brunisholz K, Horne BD, Myrick C, Miller DV, Budge D, Bader F, Everitt M, Saidi A, Stehlik J, Schmidt TC, Alharethi R. Impact of high-dose inotropic donor support on early myocardial necrosis and outcomes in cardiac transplantation. Clin Transplant. 2012 Mar-Apr;26(2):322-7. doi: 10.1111/j.1399-0012.2011.01504.x. Epub 2011 Oct 10. — View Citation

Patel ND, Weiss ES, Nwakanma LU, Russell SD, Baumgartner WA, Shah AS, Conte JV. Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the United Network for Organ Sharing Database. Circulation. 2008 Sep 30;118(14 Suppl):S83-8. doi: 10.1161/CIRCULATIONAHA.107.756866. — View Citation

Shah MR, Starling RC, Schwartz Longacre L, Mehra MR; Working Group Participants. Heart transplantation research in the next decade--a goal to achieving evidence-based outcomes: National Heart, Lung, And Blood Institute Working Group. J Am Coll Cardiol. 2012 Apr 3;59(14):1263-9. doi: 10.1016/j.jacc.2011.11.050. Review. — View Citation

Smits JM, De Pauw M, de Vries E, Rahmel A, Meiser B, Laufer G, Zuckermann A. Donor scoring system for heart transplantation and the impact on patient survival. J Heart Lung Transplant. 2012 Apr;31(4):387-97. doi: 10.1016/j.healun.2011.11.005. Epub 2011 Dec 16. — View Citation

Weiss ES, Allen JG, Kilic A, Russell SD, Baumgartner WA, Conte JV, Shah AS. Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation. J Heart Lung Transplant. 2012 Mar;31(3):266-73. doi: 10.1016/j.healun.2011.10.004. Epub 2011 Nov 16. — View Citation

Wever Pinzon O, Stoddard G, Drakos SG, Gilbert EM, Nativi JN, Budge D, Bader F, Alharethi R, Reid B, Selzman CH, Everitt MD, Kfoury AG, Stehlik J. Impact of donor left ventricular hypertrophy on survival after heart transplant. Am J Transplant. 2011 Dec;11(12):2755-61. doi: 10.1111/j.1600-6143.2011.03744.x. Epub 2011 Sep 11. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Donor left ventricular ejection fraction, troponin, BNP, EKG changes (arrhythmias, QT prolongation, repolarization abnormalities, LVH, Q waves)	To identify clinical correlates of cardiac function in potential donors being evaluated for heart transplantation.	5 years
Primary	Identify decline codes for donor hearts not accepted for transplant	To prospectively study reasons for non-acceptance of hearts offered for transplantation.	5 years
Primary	Create a statistical tools (e.g. risk prediction model) for donor heart acceptance	To develop clinical tools to assist transplant centers with real-time decisions regarding donor heart acceptance.	5 years