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Selecting oversized donor cardiac allografts for patients with pulmonary hypertension may be unnecessary
M H Kwon1, S Wong1, M Kittleson2
1Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Insights
For heart transplant recipients with mild to moderate pulmonary hypertension, both undersized and oversized donor hearts show similar outcomes. This finding challenges the common practice of favoring larger donor hearts for these patients.
Area of Science:
- Cardiology
- Transplant Surgery
- Pulmonary Hypertension Research
Background:
- Current heart transplant practices often favor oversized donor hearts for recipients with mild to moderate pulmonary hypertension (PHTN).
- The efficacy of using undersized versus oversized donor hearts in this specific patient population remains a subject of investigation.
Purpose of the Study:
- To compare the outcomes of heart transplant recipients who received either undersized or oversized donor hearts.
- To evaluate the impact of donor-to-recipient weight ratio on hemodynamic function and survival in patients with perioperative pulmonary hypertension.
Main Methods:
- Retrospective review of 107 heart transplant cases between 2003 and 2008.
- Patients were divided into undersized (donor weight/recipient weight ≤ 0.90) and oversized (donor weight/recipient weight ≥ 1.2) donor groups.
- Perioperative pulmonary hypertension was defined as systolic pulmonary artery pressure (SPAP) ≥ 40 mm Hg; mortality and hemodynamic data were analyzed.
Main Results:
- No significant differences were observed in right ventricular function at 1 week, 1 month, or 6 months between the undersized (n=37) and oversized (n=70) donor groups.
- Left ventricular function at 6 months was similar between groups (P = .22).
- Survival rates at 1 month, 1 year, and 3 years were comparable for both undersized and oversized donor heart recipients.
Conclusions:
- Both undersized and oversized donor hearts demonstrate equivalent outcomes in heart transplant recipients with mild to moderate perioperative pulmonary hypertension.
- The resolution of pulmonary hypertension over time further supports that the preference for oversized donor hearts may not be necessary.
- These findings suggest a potential shift in donor selection criteria for heart transplantation in patients with pulmonary hypertension.
Introduction:
There is a tendency to favor oversized donor hearts for heart transplant candidates affected by mild to moderate pulmonary hypertension (PHTN). We hypothesize that both undersized and oversized donor hearts fare equally well in this setting.
Methods:
A total of 107 cases from 2003 to 2008 were retrospectively reviewed and subsequently divided into those receiving organs from undersized donors (group 1: donor weight/recipient weight ≤ 0.90, n = 37) and oversized donors (group 2: donor weight/recipient weight ≥ 1.2, n = 70). PHTN was identified in the perioperative period in those patients with systolic pulmonary artery pressure (SPAP) ≥ 40 mm Hg. Endpoints of mortality and hemodynamic data were investigated.
Results:
Of 107 patients, 37 received undersized donor allografts, with a mean donor-to-recipient weight ratio of 0.8, and 70 received oversized donors allografts, with a mean donor-to-recipient ratio of 1.4. Perioperative PAH was diagnosed in 20 of the 37 (54%) patients from the undersized group (mean SPAP = 45.9 mm Hg) and 41 of 70 (59%) patients from the oversized group (mean SPAP = 46.5 mm Hg). There was no significant difference in right ventricular function at 1 week, 1 month, or 6 months. Left ventricular function was similar between both groups at 6 months (P = .22). The mean SPAP in the undersized group was 45.9, 33.4, 31.8, and 23.1 mm Hg at the perioperative, 1 week, 1 month, and 6 month time points, respectively. Corresponding mean SPAP for the oversized group was 46.5, 35.0, 29.4, and 26.1 mm Hg. The 1 month, 1 year, and 3 year survivals were similar in both groups.
Conclusions:
Oversized and undersized donor hearts fared equally well in the setting of mild to moderate perioperative PAH. This in addition to the propensity for resolution of pulmonary hypertension over time suggests that the current practice of favoring oversized donor hearts for patients with pre-transplantation PAH may be unwarranted.
