Heart transplantation in Ukraine during wartime: A retrospective cohort study of standard vs marginal donor heart transplantation outcomes.

BACKGROUND

Heart transplantation (HTx) is the gold standard for end-stage heart failure treatment, yet donor shortages limit its availability. In Ukraine, legislative reforms in 2019 spurred HTx growth, but the ongoing war halted progress and disrupted logistics. This study evaluates outcomes of orthotopic HTx, focusing on use of marginal donor hearts to expand the traditional donor pool.

METHODS

We conducted a retrospective cohort study of 106 consecutive HTx cases at the Heart Institute of the Ministry of Health of Ukraine from December 2019 to October 2024. Data included donor and recipient characteristics, surgical details, complications, and survival. Marginal donors were defined by criteria such as age >55 years, ischemic time >240 minutes, or weight mismatch. Outcomes were compared between standard (n = 67) and marginal (n = 39) donor groups using Kaplan-Meier survival analysis and nonparametric tests.

RESULTS

Median donor and recipient age were 47 and 48.5 years, respectively; 36.7% of donors were marginal. Median ischemic time was 80 minutes, similar between groups (p = 0.554). Postoperative complications (e.g., primary graft dysfunction, 10.4%) and survival (1-year: 87.7%, 2-year: 86.7%) showed no significant differences between groups (log-rank p = 0.709). Marginal donors increased the donor pool by ∼40%.

CONCLUSIONS

Utilizing marginal donor hearts in Ukraine's HTx program expanded organ availability without compromising outcomes, offering a viable strategy amidst war-related challenges.