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Impact of donor left ventricular hypertrophy on survival after heart transplant

O Wever Pinzon1, G Stoddard, S G Drakos

  • 1UTAH Cardiac Transplant Program, University of Utah Health Sciences Center, Salt Lake City, UT, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|September 13, 2011
PubMed

Insights

Donor heart left ventricular hypertrophy (LVH) does not impact recipient survival overall. However, donor LVH combined with older donor age or longer ischemic times increases mortality risk after heart transplant.

Area of Science:

  • Cardiology
  • Transplant Surgery
  • Organ Transplantation

Background:

  • Left ventricular hypertrophy (LVH) in donor hearts is a potential risk factor for allograft failure.
  • Previous studies on donor LVH and transplant outcomes have yielded inconsistent results.
  • Quantifying the precise impact of donor LVH on recipient survival is crucial for optimizing heart transplant protocols.

Purpose of the Study:

  • To investigate the association between donor left ventricular hypertrophy (LVH) and recipient survival after heart transplantation.
  • To determine if donor LVH, categorized by echocardiographic guidelines, affects short-term and long-term outcomes.
  • To identify specific subgroups of recipients or donors where donor LVH may pose a significant risk.

Main Methods:

  • Utilized the United Network for Organ Sharing (UNOS) database for a large-scale retrospective cohort study.
  • Analyzed data from 2626 heart transplant recipients with follow-up up to 3.3 years.
  • Classified donor hearts into three groups based on American Society of Echocardiography LVH criteria: no LVH (<1.1 cm), mild LVH (1.1-1.3 cm), and moderate-severe LVH (≥ 1.4 cm).

Main Results:

  • Overall, donor LVH was not found to be an independent predictor of recipient mortality.
  • Mild LVH was observed in 38% and moderate-severe LVH in 5.6% of transplanted allografts.
  • Subgroup analysis revealed an increased risk of death in recipients of allografts with LVH when associated with donor age >55 years or ischemic time ≥ 4 hours.

Conclusions:

  • In the current era, approximately half of allografts exhibit LVH, and recipient survival is comparable to those without LVH.
  • The presence of donor LVH alone does not significantly compromise recipient survival.
  • Combining donor LVH with other high-risk factors, such as advanced donor age or prolonged ischemia, may elevate mortality risk, warranting careful consideration in donor selection and management.

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