HEMODYNAMIC FOLLOW-UP OF CARDIAC ALLOGRAFTS FROM POISONED DONORS

Background The current shortage of donor organs, combined with an incr easing demand for cardiac allografts, means that extended donor criter ia are becoming more and more accepted. The use of cardiac allografts for transplantation from donors after acute poisoning is still under d iscussion; few data are currently available in the medical literature. We describe our experience with 19 orthotopic heart transplant recipi ents of organs from donors after acute intoxication with different age nts. Methods. Between March 1989 and December 1997, 883 orthotopic hea rt transplantations were performed at our transplant unit. Within this group, we accepted donor hearts after ethanol intoxication (n=1), ben zodiazepine (n=1), alkylphosphate (E 605) in combination with beta-blo cker intoxication (n=1), carbon monoxide poisoning (n=5), digitalis (n =1), digitalis/glibenclamide (n=1), chlormethiazole (n=1), propoxyphen e (n=1), alkylphosphate (E 605) (n=1), insulin (n=2), neprobamate/thio cyacide/flurazepam (n=1), paracetamol (n=1), carbamazepine (n=1), and cyanide (n=1) intoxication, At the time of organ explantation, hemodyn amic data were available from all patients. Results. Early mortality i n this group was 11%; cumulative survival after 5 years was 74%. Concl usions. Based on our limited experience, cardiac allografts from donor s exposed to different kinds of poisons can be transplanted in selecte d cases. If the donor organ is not hemodynamically compromised, showin g regular filling pressures on low or mild inotropic support just befo re explantation, and if there are no electrocardiographic changes in c ombination with elevation of the transaminases, cardiac allograft tran splantation seems to be a safe and life-saving procedure.