PhD Scientific Days 2021

Budapest, 7-8 July 2021

CL_II_L: Clinical Medicine II. Lectures

Endocrine Management of Cardiac Donors: Thyroxine Supplementation during Heart Transplant

Balázs Szécsi 1, Ádám Nagy 2, János Gál 3, Béla Merkely 4, Andrea Székely 3

1 Doctoral School of Theoretical and Translational Medicine, Semmelweis University, Budapest
2 György Gottsegen Hungarian Institute of Cardiology, Department of Anesthesiology and Intensive Therapy, Budapest
3 Department of Anesthesiology and Intensive Therapy; Semmelweis University; Budapest
4 Heart and Vascular Center; Semmelweis University; Budapest

Text of the abstract

Introduction: Heart transplant (HTx) is the gold standard method for end-stage heart failure. However, allograft insufficient supply is the main limitation of further increment HTXs. Endocrine system suppression occurs frequently in severe brain injury. Deficiency of thyroxine hormone could worsen hemodynamic status via hypovolemia and impaired myocardial function.
Aims: Our aim was to assess the role of endocrine supplementation in cardiac donor management that may affect short- and long-term mortality.
Methods: 308 cardiac donors’ and recipients’ data have been reviewed retrospectively between January 2012 and January 2020 at the Heart and Vascular Center, Semmelweis University. Our study was performed in accordance with the Eurotransplant standards. 30-day, 1-year and 2-year mortality were selected as outcomes. For statistical analysis Kaplan-Meier method and Cox regression analysis were applied to estimate recipients’ survival.
Result: A total of 308 brain-dead donors were included in our final analysis. Out of them 80 (26.0%) patients were female. The median age of donors were 57.8 years (IQR {interquartile range}25-75: 48.9-63.7). 99 donors (32.1%) were supplemented with thyroxine before HTx. After the transplant 33 recipients (10.7%) died in the first 30-days, 58 patients (18.8%) in 1 year and 63 recipients (20.5%) in 2 years. Those recipients’ survival who managed to receive an allograft from a thyroxine supplemented donor were significantly higher, than those recipients’ survival who received an allograft from a donor who were not treated with thyroxine. This association was independent and significant in terms of 30-day mortality (Hazard Ratio {HR}=0.27; 95% Confidence Interval {CI}=0.10-0.77; p=0.014), 1-year mortality (HR=0.44; 95% CI=0.23-0.85; p=0.014) and 2-year mortality (HR=0.44; 95% CI=0.24-0.83; p=0.011). Our multivariable models were adjusted to UNOS recipient and UNOS donor scores.
Conclusion: Donor management has an outstanding role in HTx. Our results highlight the important role of thyroxine treatment in cardiac donors as it could have a beneficial impact on recipients’ short- and long-term survival.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine