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Donors of death due to anoxic brain injury such as suicidal hanging are at risk for a severe catecholamine surge leading to an acute myocardial stress that can cause global tissue hypoxia as well as pulmonary edema and barotrauma, all of which may potentially adversely impact myocardial tissue. Concerns have been raised about potential higher rates of Primary Graft Dysfunction (PGD) in heart transplant recipients of such donors due to this acute myocardial stressor. We wanted to assess if this mechanism of donor death does carry an increased risk of PGD or other adverse outcomes in our single center experience. Between January 2014 and July 2019, 331 heart transplantations were performed at our center. Seventeen patients received a heart from donors after suicidal hanging, confirmed by review of the United Network for Organ Sharing UNet DonorNet database. Three out of 17 recipients (18%) from suicidal hanging donors experienced primary graft dysfunction (PGD) peri-operatively requiring extracorporeal membrane oxygenation (ECMO). In comparison, 29 out of 314 recipients (9%) from all other donors during this time period experienced PGD requiring peri-operative ECMO (p = 0.25). The 30-day and 1-year survival among recipients of grafts from suicidal hanging donors were 16/17 (94%) and 16/17 (94%), respectively. The one death during this period was due to complications from PGD (multi-system organ failure, ischemic limb with ECMO). Overall, in a large-volume, single-center experience, while there was a trend toward a higher incidence of PGD requiring ECMO, transplantation of a heart from a suicidal hanging donor was not associated with a higher 30-day and 1-year mortality. Thus, these results suggest that hearts from suicidal hanging donors may be appropriately considered for transplantations, with heightened awareness of a possible increased risk of PGD requiring ECMO. [ABSTRACT FROM AUTHOR]

Purpose Malignancy remains a major cause of morbidity and mortality after HT with limited predictors of outcome. Given that development of malignancy (CA) is linked to degree of immunosuppression, we sought to evaluate the incidence of malignancy and its potential correlation with immune function assay (IFA) results pre and post-CA diagnosis in HT. Methods 2100 adult and pediatric OHTs performed at our institution March 1991 and April 2018 were analyzed. Pre-HT CA was correlated with post-HT recurrence or development of new CA. IFA results were assessed at the time of CA diagnosis and 3m/6m/12m prior. Multivariate Cox proportional hazard regression analysis was performed. Results A total of 55 OHT (2.6%) had either pre- (12) or post-OHT (48) malignancy (CA). The majority of patients were male (83.6%, p0.06), Caucasian (72.7%, p=0.0006), and had smoking hx (49.1%, p=0.004). 33% had a family hx of CA. Treated rejection was associated with increased risk of post-Tx CA (p<0.01) but not induction therapy (p=0.77). Median time from HT to CA was 4.7y (0.14-25.8). 43 patients developed post-HT CA with no prior CA history. Five patient with pre-HT CA developed post-HT CA, 2 with recurrence (prostate, BCC). Seven patients with pre-HT CA (4 lymphomas) continue to be CA-free post-HT. Three patients expired due to CA. IFA results were not overtly low and did not differ significantly at 12m/6m/3m intervals prior to CA diagnosis. Conclusion Low immune function assay results were not seen prior to diagnosis of CA, as expected, and results demonstrated minimal variability. Further study is warranted to better understand the potential correlation of immune function assay results with development of post-HT malignancy. [ABSTRACT FROM AUTHOR]