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Risk factors for rejection for morphological reasons of heart valves for transplantation


The study aim was to identify risk factors for morphological rejection of aortic and pulmonary valves for transplantation that could be used to optimize donor selection. The files of all Dutch heart valve donors, donating in a 2.5 years period, whose hearts were processed at Heart Valve Bank Rotterdam, were reviewed for all factors that could be relevant for valve rejection and related to outcome of morphological assessment of the valves. Valves were retrieved from 813 deceased Dutch donors, 24.1% also donating organs. For 797 aortic and 767 pulmonary valves, who met retrieval criteria, morphological assessment was done. 69.5% of aortic and 37.5% of pulmonary valves were considered unsuitable for transplantation at morphological assessment. Backward stepwise multivariate logistic regression analysis, showed age, cardiac cause of death, cerebrovascular accident as cause of death or in medical history, and number of cardiovascular risk factors in a donor to be independent risk factors for morphological rejection of aortic valves. Age, sex, weight >100 kg and ruptured aortic aneurysm as cause of death were independent risk factors for morphological rejection of pulmonary valves. Being an organ donor was an independent predictor of morphological approval of aortic and pulmonary valves, while hypertension was an independent predictor for morphological approval of aortic valves. Thus, independent factors were identified that are associated with morphological rejection of aortic and pulmonary valves for transplantation, and that could be used to optimize donor selection by preventing unnecessary retrievals, limiting costs, while improving yield per donor with minimal compromise for availability.

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  1. Commission Directive 2006/17/EC: Technical requirements for donation, procurement and testing of human tissues and cells. Official Journal of the European Union. February 8, 2006

  2. Goffin YA, Van Hoeck B, Jashari R et al (2000) Banking of cryopreserved heart valves in Europe: assessment of a 10-year operation in the European Homograft Bank (EHB). J Heart Valve Dis 9:207–214

  3. Grinda J, Mainardi J, D’Attellis N et al (2005) Cryopreserved aortic viable homograft for active endocarditis. Ann Thorac Surg 79:767–771

  4. Grosse K, Meyer R, Schmitzer E et al (2008) Are heart valves from donors over 65 years of age morphologically suitable for transplantation? Cell Tissue Bank 9:31–36

  5. Grosse K, Meyer R, Schmitzer E, et al. (2010) How effective are heart valve transplants from organ donors of 65–70 years of age? Oral presentation at the European Association of Tissue Banks Annual Meeting 2010, Berlin, Nov 6

  6. Hunt CJ, Caffrey EA, Large SR (1998) Factors affecting the yield of cardiac valve allografts from living unrelated donors. Eur J Cardiothorac Surg 13(1):71–77

  7. Parker R (1997) An international survey of allograft banks. In: Yankah AC, Yacoub MH, Hetzer R (eds) Cardiac valve allografts. Springer, Berlin

  8. Reinhartz O, Reddy V, Petrossian E et al (2006) Homograft valve right ventricle to pulmonary artery conduit as a modification of the Norwood procedure. Circulation 114:1594–1599

  9. Ross DN (1962) Homograft replacement of the aortic valve. Lancet 2:488

  10. Soo A, Healy DG, El-Bashier H, et al. (2010) Quality control in homograft valve processing: when to screen for microbiological contamination? Cell Tissue Bank. doi:10.1007/s10561-010-9180-x

  11. Van Kats JP, Van Tricht C, Van Dijk A et al (2010) Microbiological examination of donated human cardiac tissue in heart valve banking. Eur J Cardiothorac Surg 37(1):163–169

  12. Wilson PWF (2010) Overview of the risk factors for cardiovascular disease. UptoDate, last updated Oct 2010. www.uptodate.com, accessed May 2011

  13. Wilson A, Crouch K, Tucker P, Brubaker S (2004) Effects of donor medical and social history information on the utility of semilunar heart valves. American Association of Tissue Banks 28th Annual Meeting 2004

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Correspondence to Marja J. van Wijk.

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van Wijk, M.J., van den Bogaerdt, A. & Bokhorst, A.G. Risk factors for rejection for morphological reasons of heart valves for transplantation. Cell Tissue Bank 14, 125–132 (2013). https://doi.org/10.1007/s10561-011-9267-z

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  • Heart valves
  • Transplantation
  • Homograft
  • Risk factors
  • Morphology