Early donor heart failure following transplantation from myocardial injury sustained during brain death

Abstract

In an experimental study in the Chacma baboon, the induction of brain death was followed by myocardial structural damage in 6 out of 10 (60%) animals. This damage, which is believed to be related to intense sympathetic nervous system activity resulting in the prolonged release of myocardial endogenous catecholamines, predominantly consists of various forms of myocardial necrosis (contraction bands, coagulative myocytolysis, coagulative necrosis), and of focal interstitial mononuclear cell infiltration and edema. We have reviewed those patients who died following heart transplantation at the Universities of Cape Town and Munich from hitherto unexplained causes either at operation or in the early post‐transplant period. Five out of 106 patients (4.7%) showed donor heart histopathological features almost identical to those seen in our experimental study. Details of these 5 patients are given. We suggest that myocardial damage sustained during the agonal period may be a major factor in those patients in whom donor heart failure occurred early during the post‐transplant period.